Timing of surgery for proximal humeral fracture treated with shoulder hemiarthroplasty, best results with surgery within 2 weeks

Background: Preoperative delay may affect the outcome of proximal humerus fractures treated with shoulder hemiarthroplasty. There is currently no consensus for the recommended preoperative time interval. The aim was to examine how the time to surgery with shoulder hemiarthroplasty after a proximal humerus fracture affected patient-reported outcome. Methods 380 patients with proximal humerus fractures treated with shoulder hemiarthroplasty recorded from the Swedish Shoulder Arthroplasty Registry were included. Three self-reporting outcome instruments were used at follow-up after 1-5 years: a shoulder specific score, the Western Ontario Osteoarthritis of the Shoulder index (WOOS), the EuroQol health status component (EQ-5D-index) and subjective patient satisfaction assessment. Results Preoperative delay had a negative impact on the WOOS, EQ-5D and patient satisfaction scores (p < 0.01). The best result, measured with WOOS at minimum 1-year follow-up, was found when surgery was performed 6-10 days after the reported date of fracture. A delay of more than 10 days was shown be correlated with poorer outcomes. Conclusions The current recommendation in Sweden to perform shoulder hemiarthroplasty within two weeks after sustaining a proximal humerus fracture is considered valid.