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Background <p>Reverse 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.</p> Methods <p>PubMed, 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.</p> Results <p>Seventeen 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, <i>P</i> &lt; 0.001), greater range of motion (ROM) (abduction: WMD = 11.32°, <i>P</i> &lt; 0.001; forward flexion: WMD = 11.51°, <i>P</i> &lt; 0.001; external rotation: WMD = 3.77°, <i>P</i> = 0.048) and statistically superior shoulder functional scores (Constant-Murley score: WMD = 5.57, <i>P</i> &lt; 0.001; American Shoulder and Elbow Surgeons score: WMD = 10.38, <i>P</i> &lt; 0.001; Simple Shoulder Test score: WMD = 0.91, <i>P</i> = 0.001; Shoulder Pain and Disability Index: WMD = − 14.50, <i>P</i> &lt; 0.001), and lower risk of complications (infection: RR = 0.42, <i>P</i> = 0.019; dislocation: RR = 0.34, <i>P</i> = 0.007; nerve palsy: RR = 0.49, <i>P</i> = 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%).</p> Conclusions <p>In 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.</p> Trial registration <p>CRD42024534751.</p>

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Immediate reverse shoulder arthroplasty demonstrates better outcomes than salvage reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年3月15日

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  • Xinxin Du,
  • Rui Han,
  • Hua Li

摘要

Background

Reverse 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.

Methods

PubMed, 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.

Results

Seventeen 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%).

Conclusions

In 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 registration

CRD42024534751.