Timing of Surgery for Proximal Humeral Fracture Treated with Shoulder Hemiarthroplasty, Best Results with Surgery
Yilmaz Demir1,2, Alma Vuorinen2, Max Gordon1,2
1Orthopedic Department, Danderyd Hospital, 182 88 Stockholm, Sweden.
Background:
Preoperative delay may affect the outcome of proximal humerus fractures treated with shoulder hemiarthroplasty. There is currently no consensus for the recommended preoperative time interval. The aim was to examine how the time to surgery with shoulder hemiarthroplasty after a proximal humerus fracture affected the patient-reported outcome.
Methods:
380 patients with proximal humerus fractures treated with shoulder hemiarthroplasty recorded from the Swedish Shoulder Arthroplasty Registry were included. Three self-reporting outcome instruments were used at follow-up after 1-5 years: a shoulder-specific score, the Western Ontario Osteoarthritis of the Shoulder index (WOOS), the EuroQol-5 Dimension index (EQ-5D), and subjective patient satisfaction assessment.
Results:
The preoperative delay had a negative impact on the WOOS, EQ-5D, and patient satisfaction level (p < 0.01). The best result, measured with WOOS at a minimum 1-year follow-up, was found when surgery was performed 6-10 days after the reported date of fracture. WOOS% 8-14 days was 69.4% (± 24.2). A delay of more than 10 days was shown to be correlated with poorer outcomes. WOOS% 15-60 days was 55.8% (± 25.0) and continued to decrease.
Conclusion:
The current recommendation in Sweden to perform shoulder hemiarthroplasty within 2 weeks after sustaining a proximal humerus fracture is considered valid.
