SynthesisJournal of orthopaedic surgery and research2026
Immediate reverse shoulder arthroplasty demonstrates better outcomes than salvage reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a meta-analysis.
Synthesis in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReverse shoulder arthroplasty (RSA) is a promising option for proximal humerus fractures (PHFs) and also used as a salvage procedure for failed treatment. Whether the timing of RSA would influence the clinical outcomes is controversial. This meta-analysis compared outcomes between immediate RSA (iRSA) and salvage RSA (sRSA) in geriatric patients with PHFs.
methodsPubMed, Embase, Web of Science and Cochrane Library databases were searched up to 1st April 2024. Comparative studies reporting outcomes of iRSA and sRSA in geriatric patients with PHFs were included. A random-effects model was used for meta-analysis. The primary outcome was the revision rate. Secondary outcomes included shoulder function and complications. Risk ratios (RR) were calculated for dichotomous outcomes, and weighted mean differences (WMDs) were used for continuous variables. Meta-regression model and subgroup analysis were used to explore sources of potential heterogeneity for the primary outcome.
resultsSeventeen studies with 27,756 cases (24442 receiving iRSA and 3314 receiving sRSA) were included. Compared with sRSA, iRSA was associated with a lower risk of revision (RR = 0.41, P < 0.001), greater range of motion (ROM) (abduction: WMD = 11.32°, P < 0.001; forward flexion: WMD = 11.51°, P < 0.001; external rotation: WMD = 3.77°, P = 0.048) and statistically superior shoulder functional scores (Constant-Murley score: WMD = 5.57, P < 0.001; American Shoulder and Elbow Surgeons score: WMD = 10.38, P < 0.001; Simple Shoulder Test score: WMD = 0.91, P = 0.001; Shoulder Pain and Disability Index: WMD = - 14.50, P < 0.001), and lower risk of complications (infection: RR = 0.42, P = 0.019; dislocation: RR = 0.34, P = 0.007; nerve palsy: RR = 0.49, P = 0.026). The meta-regression model and subgroup analysis showed that sRSA after failed prior surgery had the highest revision rate (9.4%) as compared with iRSA (3.7%).
conclusionsIn elderly patients with PHFs, iRSA is associated with lower revision and complication rates, as well as statistically superior shoulder function and ROM, compared with sRSA. However, the clinical significance of some functional differences remains uncertain.
trial registrationCRD42024534751.
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