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Clinical and radiographic outcomes of hemiarthroplasty for proximal humeral fractures in Korea with three or more years of follow-up: a retrospective cohort study
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Sang Jin Cheon, Kyu-Hak Jung, Min Hyeok Choi, Suk-Woong Kang
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Received October 27, 2025 Accepted December 8, 2025 Published online February 26, 2026
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DOI: https://doi.org/10.12671/jmt.2025.00325
[Epub ahead of print]
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 Abstract
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- Background
Shoulder hemiarthroplasty (HA) is an established treatment option for complex proximal humeral fractures, particularly in cases involving severe comminution or osteoporotic bone. This study investigated the clinical and radiographic outcomes of HA with a minimum follow-up of 3 years and aimed to identify prognostic factors associated with postoperative function.
Methods
We retrospectively reviewed 44 patients (16 males and 28 females; mean age, 61.2 years; range, 23–83 years) who underwent shoulder HA for complex proximal humeral fractures between 2005 and 2018. The mean follow-up duration was 70.4 months (range, 36–168 months). Clinical evaluations included the Constant score, visual analog scale pain score, patient satisfaction, and range of motion. Radiographic assessments examined tuberosity healing, radiolucent lines, acromiohumeral distance (AHD), and glenoid arthrosis.
Results
At the 3-year follow-up, 64% of patients reported being satisfied or very satisfied. The mean Constant score was 46.6 (range, 13–71), and the age- and sex-adjusted Constant score was 53.5 (range, 19–92). Radiographically, 23% of patients demonstrated radiolucent lines, and 41% showed evidence of glenoid arthrosis. Tuberosity absorption occurred in 39% of patients, with a mean onset of 11.2 months postoperatively, and was significantly associated with lower Constant scores and reduced range of motion. Patients younger than 60 years demonstrated better functional outcomes and lower rates of tuberosity absorption. The mean AHD decreased from 8.4 mm postoperatively to 4.4 mm at the 3-year follow-up (P<0.001).
Conclusions
Shoulder HA for complex proximal humeral fractures yielded satisfactory pain relief and functional outcomes, particularly when tuberosity healing was preserved. However, elderly patients with diminished bone quality were more likely to develop tuberosity absorption and experience poorer functional recovery. Meticulous surgical technique and careful postoperative surveillance remain essential to achieving optimal results.
Level of evidence: III.
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