If you are an older adult who breaks the top of your arm bone near the shoulder, you face a tough choice: get a new artificial joint or have the bone pieces put back together with a metal plate and screws. A new analysis of more than 34,000 patients aged 65 and older suggests that the artificial joint, called reverse shoulder arthroplasty (RSA), may give you a little more ability to lift your arm forward. But the two surgeries end up with similar overall shoulder function and complication rates.
Researchers combined data from multiple studies, including randomized trials and large patient registries, to compare RSA with open reduction and internal fixation (ORIF) for complex proximal humeral fractures. These are serious breaks where the bone is shattered into several pieces, often in people with weak bone from aging or osteoporosis. The analysis included over 34,000 patients, making it one of the largest comparisons of these two procedures.
The main finding was that patients who received RSA could lift their arm forward (forward flexion) more than those who had ORIF. There was also a trend toward better ability to lift the arm out to the side (abduction) with RSA. However, for twisting the arm inward (internal rotation), ORIF appeared slightly better, though the difference was not statistically significant. For twisting outward (external rotation), there was no difference. When it came to overall shoulder function measured by standard scores like the Constant-Murley score and Oxford Shoulder Score, both surgeries produced similar results. Complication rates and the need for repeat surgery were also about the same.
No specific safety concerns were reported in the analysis, but any major surgery carries risks like infection, nerve damage, and blood clots. The study did not detail adverse events for each group.
It is important to keep in mind that this is a review of existing studies, not a single perfect experiment. The quality of the included studies varied, and the analysis combined data from different types of research, including observational studies that cannot prove cause and effect. The authors note that high-quality randomized trials are still needed to confirm these findings. Also, the advantage in forward flexion was modest, and it did not translate into better overall function or fewer complications.
For patients right now, this means that RSA may be a reasonable option if you have poor bone quality or rotator cuff problems, because the reverse design does not rely on your own tendons to work. ORIF remains a good choice if your bone is strong enough and you want to keep your natural joint. Talk to your orthopedic surgeon about which option fits your specific fracture pattern, bone health, and activity goals.