Shoulder Replacement for Proximal Humerus Fracture
in Rockhampton

What is going on

Proximal humerus fractures are the third most common fracture in older adults, typically after a fall onto the shoulder or outstretched hand. Most are stable two-part injuries that heal without operation. A subset — often older patients with osteoporotic bone or younger patients with high-energy trauma — sustain four-part fractures, fracture-dislocations, or head-splitting patterns where the bone fragments are too damaged or the blood supply too compromised for reliable plate fixation. In these cases, attempting to reconstruct the joint with plates and screws is associated with high rates of fixation failure, avascular necrosis (death of the humeral head) and need for revision surgery. Replacing the joint at the index operation, rather than after a failed fixation, generally produces a more predictable result.

Not sure if this is the right diagnosis? The shoulder pain hub and shoulder injury hub triage the differential by anatomical location.

What the operation involves

The operation is performed under regional and general anaesthesia in the beach-chair position, through an incision over the front of the shoulder. The damaged humeral head is removed; the glenoid (socket) is prepared with a baseplate and metal hemisphere, and a stemmed component with a plastic socket is implanted into the humeral shaft. The greater and lesser tuberosity fragments (which carry the rotator cuff attachments) are carefully repositioned around the prosthesis and secured with high-strength sutures, often augmented with bone graft from the removed head. The operation usually takes one to two hours; patients stay one or two nights in hospital. Full clinical detail is on the education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the shoulder replacement for proximal humerus fracture education page or the shoulder surgery overview.

How this case is handled

In-person review at two weeks for wound check and X-ray, six weeks to start active motion, three months to add strengthening, and six and twelve months to confirm functional outcome. Co-located shoulder physiotherapy is integrated into the post-operative pathway, with structured progression matched to the radiographic tuberosity healing. Patients from outside Rockhampton can transition to therapy closer to home after the early intensive sessions; the protocol is shared with the local therapist to maintain consistency.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 48919 Total or reverse shoulder arthroplasty (with bone graft)

Single item covering anatomic and reverse total shoulder arthroplasty regardless of cause; the with-graft variant is used for proximal humerus fracture arthroplasty given the tuberosity reconstruction with bone graft from the removed head

Patient questions we hear most

• Why replace the joint instead of fixing it with a plate?

  Plate fixation works well in younger patients with reconstructable fracture patterns and healthy bone. In older patients with osteoporotic bone, comminuted four-part fractures, or compromised blood supply to the head fragment, plate fixation has high rates of fixation failure, avascular necrosis of the head, and need for revision surgery. Replacing the joint at the index operation, rather than after a failed fixation, generally produces a more predictable outcome with less time spent in a sling and a more reliable return to function. The decision is individual and considers the fracture pattern, bone quality, patient age, activity level, and cuff status.

• Why a reverse replacement and not a hemiarthroplasty?

  Hemiarthroplasty (replacing only the ball, not the socket) was the historical operation for these fractures but produced unreliable outcomes — function depended heavily on whether the tuberosities and their rotator-cuff attachments healed, and a substantial proportion of patients had ongoing pain and weakness. Reverse total shoulder arthroplasty bypasses the rotator cuff entirely — the deltoid muscle drives elevation through the prosthetic geometry — and is more forgiving of tuberosity nonunion. The current evidence consistently favours reverse over hemiarthroplasty for complex fractures in older patients.

• How long does the implant last?

  Modern reverse shoulder implants have excellent survivorship — published series report 90 to 95 per cent survival at ten years, with most failures relating to glenoid loosening rather than wear. For an older fracture patient, this typically means the implant will outlast the patient's need for it. Revision is possible if loosening or infection occurs, though it is technically more complex than the index operation.

• Will I be able to lift my arm overhead?

  Most patients regain forward elevation to around 130 to 150 degrees — enough to reach a top shelf, comb their hair and dress comfortably. External rotation is typically more limited and depends on whether the tuberosity fragments heal back to the prosthesis. The functional gain over the pre-operative fracture state is substantial, and most patients describe their replaced shoulder as pain-free even when the range is not full.

• How much does shoulder replacement cost? What does Medicare cover?

  Shoulder replacement involves separate fees for the surgeon, anaesthetist, hospital and the prosthesis. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

More general questions about appointments, fees and the practice on the FAQ page.