Journal of Orthopaedic Reports (Jan 2023)

Can radiographic parameters predict favourable outcomes in proximal humeral hemiarthroplasty for fractures? – A case series

  • Shawn JS Seah,
  • Ken Lee Puah,
  • Denny Tijauw Tjoen Lie

Journal volume & issue
Vol. 2, no. 1
p. 100118

Abstract

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Background: Implant positioning and tuberosity fixation is challenging when performing proximal humerus hemiarthroplasty for proximal humerus fractures due to loss of normal anatomical landmarks. Determining tuberosity healing radiographically remains crucial. We aim to describe radiographic parameters after a proximal humerus hemiarthroplasty and assess its correlation to postoperative clinical and functional outcomes. Case details: We conducted a retrospective study of 30 patients who underwent cemented hemiarthroplasty for proximal humerus fractures from 2010 to 2016. UCLA scoring was assessed 2 years post-surgery. Radiographic parameters measured on post-operative x-ray taken at 2 years follow up include Prosthetic Acromial Interval (PAI), Greater Tuberosity Position (GTP), Humeral-Prosthetic Offset (HPO) and a novel measurement, the Glenoid Ratio (GR). The mean age and follow-up were 67.5 ​± ​12.6 years and 7.7 ​± ​4.6 years respectively. Postoperatively, two patients had lucencies around the cement mantle. Mean PAI was 7.9 ​± ​5.8 mm, GTP 9.4 ​± ​9.6 mm, HPO 26.7 ​± ​4.5 mm, GR 0.48 ​± ​0.10. Twenty-two (75.9%) patients had a GR between 0.4 and 0.6. Deltoid tuberosity index was 1.4 ​± ​0.18. There was no significant association between the radiographic parameters and UCLA scoring. Two-year mean UCLA score was 24.8 ​± ​5.1.9/29 (31.3%) patients had a good UCLA score. No revisions, infections or periprosthetic fractures were seen at latest follow up. Conclusion: Rotator cuff integrity and healing of tuberosities in proximal humerus hemiarthroplasty are important factors for successful hemiarthroplasty. This study explored the use of radiographic measurements to determine tuberosity position and hence infer rotator cuff integrity. However, these measurements do not correlate with the clinical outcome in this series of patients. Serial measurements of these measurements may correlate with functional outcomes and should be studied.

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