SHOULDER Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study Emilio Sebasti  a-Forcada, MD a , Rom  an Cebri  an-G  omez, MD a , Alejandro Lizaur-Utrilla, MD, PhD a, *, Vicente Gil-Guill  en, MD, PhD b a Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain b Unit of Clinical Investigation, Elda University Hospital, Alicante, Spain Background: There is no consensus on what type of arthroplasty is best for the treatment of complex prox- imal humeral fractures in elderly patients. The purpose of this prospective study was to compare the out- comes of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA). Methods: Sixty-two patients older than 70 years were randomized to RSA (31 patients) and HA (31 pa- tients). One HA patient died at 1 year, and she was excluded. The mean follow-up was 28.5 months (range, 24-49 months). Results: Compared with HA patients, RSA patients had significantly higher (P ¼ .001) mean University of California–Los Angeles (29.1 vs 21.1) and Constant (56.1 vs 40.0) scores, forward elevation (120.3  vs 79.8  ), and abduction (112.9  vs 78.7  ) but no difference in internal rotation (2.7  vs 2.6  ; P ¼ .91). The Disabilities of the Arm, Shoulder, and Hand score was higher in the HA patients (17 vs 29; P ¼ .001). In the HA group, 56.6% of tuberosities healed and 30% resorbed. Patients with failure of tu- berosities had significantly worse functional outcomes. There were 2 complications (intraoperative humer- al fracture and superficial infection). One patient was manipulated under general anesthesia because of postoperative stiffness. Six patients with HA had proximal migration that required revision to RSA. In the RSA group, 64.5% of tuberosities healed and 13.2% resorbed. Functional outcome was irrespective of healing of the tuberosities. Notching was observed in only 1 RSA patient. One patient developed a he- matoma and another a deep infection requiring a 2-stage revision to another RSA. Conclusion: RSA resulted in better pain and function and lower revision rate. Revision from HA to RSA does not appear to improve outcomes. Level of evidence: Level I, Randomized Controlled Trial, Treatment Study. Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Proximal humeral fracture; reverse shoulder arthroplasty; hemiarthroplasty This study was approved by the Comit e  Etico de Investigaci on Cl  ınica (CEIC), Hospital Universitario de Elda (study reference number: PI2009- 11), and informed consent was obtained. *Reprint requests: Alejandro Lizaur-Utrilla, MD, PhD, Departamento Cirugia Ortop edica, Hospital Universitario de Elda, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain. E-mail address: lizaur1@telefonica.net (A. Lizaur-Utrilla). J Shoulder Elbow Surg (2014) 23, 1419-1426 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2014.06.035