Reverse arthroplasty compared to hemiarthroplasty and open reduction and internal fixation for displaced proximal humerus fracture in patients above 60: a Bayesian network meta-analysis

INTRODUCTION: The present Bayesian network meta-analysis compared reverse total shoulder arthroplasty (rTSA) to hemiarthroplasty (HA) and open reduction and internal fixation (ORIF) for displaced proximal humeral fractures (PHF) in patients above 60. METHODS: This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In December 2024, PubMed, Web of Science, and Embase databases were accessed. No time constraint was set for the search. All clinical studies were accessed comparing rTSA, ORIF and HA for displaced PHF in patients older than 60. Only studies which compared at least two of the interventions of interest were eligible when they reported a minimum of 12 months of follow-up. Two-, three-, and four-part displaced fractures and fractures with a head-splitting component were considered. RESULTS: Data from 878 procedures were collected. 72% (631 of 878 patients) were women. The mean length of the follow-up was 33.8 ± 14.8 months. The mean age of the patients was 73.4 ± 4.6 years. Between groups, comparability was found in the mean age, the ratio of men to women, the length of the follow-up, and the time elapsed from injury to the procedure. The rTSA demonstrated the lowest rate of complications, followed by HA and ORIF. The rTSA demonstrated the lowest rate of revision, followed by HA and ORIF. Given the limited and heterogeneous data, only complications and revision rates were analysed in the network meta-analysis; functional outcomes were discussed narratively. CONCLUSION: In patients above 60 with displaced PHF, rTSA was associated with a lower complication and revision rate than ORIF and HA. LEVEL OF EVIDENCE: Level IV, systematic review and meta-analysis.