Hemiarthroplasty is indicated in all cases where a stable osteosynthesis is not achievable especially in situations with poor bone quality like severe osteoporosis. 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.
Keys to successful hemiarthroplasties
Correct determination of the surgical landmarks
Proper determination of prosthesis size and version
Proper height of the prosthesis with correct soft-tissue tensions
Anatomical reduction of the tuberosities
Stable fixation of the tuberosities (with cables or other stout sutures) to promote their union to the proximal humerus
Autologous bone grafting underneath the tuberosities