Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus

Thirty-nine consecutive patients with 3- and 4-part proximal humeral fractures and fracture dislocations were treated with hemiarthroplasty. After an average of 42 months (range 5 to 98 months) of Follow-up, 17 women and 8 men (average age 64.5 years) were evaluated with the University of California-Las Angeles (UCLA) scale, the Constant-Murley scale, the Hospital for Special Surgery (HSS) scale, and the visual analogue scale. Fair, good, or excellent results were achieved in 80% of the patients on the UCLA and Visual scales, in 72% of the patients on the HSS scale, and in 44% of the patients on the Constant-Murley scale. The highest correlation was between the HSS score and the Visual analogue score. According to the UCLA and Constant-Murley results, the outcome after early (<4 weeks) humeral head replacement was significantly better than after late (greater than or equal to 4 weeks) humeral head replacement (UCLA score, P = .02; Constant-Murley score, P = .01). After early hemiarthroplasty active forward flexion was significantly better (P = .035). Thus the decision to perform prosthetic humeral head replacement in elderly patients should be made as early as possible after trauma.