Hemiarthroplasty is indicated in all cases where a stable osteosynthesis is not achievable especially in situations with poor bone quality like severe osteoporosis or significant comminution. In the elderly, the indication might be extended to head-splitting fractures and situations with a probably ischemic humeral head (eg, a displaced anatomical neck fracture with no capsular attachment remaining).
The reverse shoulder prosthesis may have a role for arthroplasty in elderly patients with comminuted proximal humerus fractures. Tuberosity healing is less predictable in the elderly. Their function may be improved by using this type of prosthesis.