Related Experiment Video
Updated: Feb 14, 2026

Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Outcomes of reverse total shoulder arthroplasty vs. other surgical fixation methods for proximal humerus fractures in
Julie Mekhail1, Ryan Mullan2, James L Cross2
1Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT, USA.
Background:
Proximal humerus fractures (PHFs) are among the most common osteoporotic injuries in elderly patients, typically resulting from low-energy mechanisms such as ground-level falls. Multiple surgical options exist, including reverse total shoulder arthroplasty (rTSA), open reduction and internal fixation (ORIF), and hemiarthroplasty (HA), but the optimal treatment remains debated. This up-to-date systematic review and meta-analysis aimed to evaluate the comparative effectiveness of rTSA, HA, and ORIF for treating PHFs in the geriatric population.
Methods:
A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), EMBASE, and Web of Science were searched through January 2025. Eligible studies included randomized controlled trials or cohort studies comparing rTSA with HA and/or ORIF in patients aged ≥ 65 years. Two reviewers independently screened studies using predefined inclusion criteria. The primary outcome was postoperative functional scores; secondary outcomes included: complication rates, revision surgery rates, shoulder range of motion, and quality of life metrics.
Results:
Twenty studies met the inclusion criteria. rTSA demonstrated significantly better Constant-Murley Scores (standardized mean difference [SMD] = 0.67, P < .001), visual analog scale pain scores (SMD = -0.36, P = .034), forward flexion (SMD = 0.95, P < .001), abduction (SMD = 0.90, P < .001), and complication rates (risk ratio = 0.79, P = .047) than HA. Compared to ORIF, rTSA was associated with significantly lower revision rates (risk ratio = 0.31, P < .001), with no difference in functional outcomes or complication rates. No significant differences in mortality rates were observed between rTSA and either HA or ORIF.
Conclusion:
rTSA offers superior functional outcomes and complication rates compared to HA and a more favorable revision profile than ORIF in elderly patients with PHFs. These findings support the growing preference for rTSA as the primary surgical treatment in this population, though further high-quality, long-term studies are needed to guide individualized decision-making.
More Related Videos
15:11Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
Published on: January 5, 2015
09:31Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Related Concept Videos
Muscles of the Shoulder
Anterior Thoracic Muscles
The anterior thoracic muscles include the serratus anterior, subclavius, and...
Bones of the Upper Limb: Humerus
Predicting Reaction Outcomes
Outcomes of Glycolysis
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
Fixation and Sectioning
The simplest type of preparation is the wet mount, in which the specimen is placed in a drop of liquid on the slide. A liquid specimen can be directly deposited on the slide using a dropper. Solid specimens, such as skin scraping, can be placed on the slide before adding a drop of liquid to prepare the wet mount. Sometimes the liquid is simply water, but stains are often added...
Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...