Now in JBJS, Fraser et al. present the 5-year results of the DelPhi (Delta-PHILOS) trial, a multicenter, single-blinded randomized controlled trial. The researchers evaluated reverse total shoulder arthroplasty (RTSA) vs. open reduction and internal fixation (ORIF) in the treatment of displaced proximal humeral fractures in patients 65 to 85 years of age.
“In the present study,” write the authors, “RTSA was superior to plate fixation for displaced AO/OTA type-B2 and C2 fractures in elderly patients at 5 years. Patients 65 to 74 years of age and patients with type-C2 fractures benefited the most.”
The study, along with a downloadable visual abstract, is available at JBJS.org:
Study Highlights
The investigators found a significant difference in favor of RTSA for the Constant score, the primary outcome (mean, 71.7 vs. 58.3; difference of 13.4; p = 0.002). For patients with type-C2 fractures, they also found a significant difference in favor of RTSA (mean, 73.3 vs. 56.0; difference of 17.3; p = 0.001). A nonsignificant difference in favor of RTSA was found for patients with type-B2 fractures.
When analyzed by age, a significant difference in the Constant score (15.7; p = 0.006) in favor of RTSA was found for patients aged 65 to 74 years. For those aged 75 to 85 years, a nonsignificant difference in favor of RTSA was found.
Secondary outcomes were the Oxford Shoulder Score, radiographic measurements, and quality of life. Adverse events were also assessed.
Sixty-four patients were allocated to RTSA and 60 patients, to ORIF. The mean age of the patients was 75 years; 90% of the patients were female. Of the total 124 patients, 65 were available at 5 years for clinical testing, and an additional 6 patients replied via telephone to questions regarding patient-reported outcomes.
Read the full study at JBJS.org: Reverse Shoulder Arthroplasty Is Superior to Plate Fixation for Displaced Proximal Humeral Fractures in the Elderly. Five-Year Follow-up of the DelPhi Randomized Controlled Trial.
Interested in other Shoulder and Elbow content? Explore JBJS content by subspecialty: What’s Trending in Shoulder & Elbow at JBJS.org.
