Nowak LL, et al. - Individuals aged 50 years and over, who sustained a proximal humerus fractures (PHFs) between 2004 and 2015, from linkable datasets, were enrolled in order to contrast complication-related reoperation rates after primary arthroplasty for PHFs vs secondary arthroplasty for failed open reduction and internal fixation (ORIF). A total of 1,624 individuals who underwent initial arthroplasty for PHF, and 98 who underwent secondary arthroplasty after failed ORIF were recognized. Collectively, in comparison with 19 individuals in the revision arthroplasty group, 72 individuals in the primary arthroplasty group underwent a reoperation within two years after arthroplasty. Following covariable adjustment, this variation was considerably distinct. Therefore, for failed ORIF of PHF, the number of reoperations after arthroplasty vs primary arthroplasty was concluded to be notably greater, which infers that for individuals whose prognostic factors recommend a high reoperation rate after ORIF, primary arthroplasty could be a superior choice. However, prospective clinical studies are needed to validate these findings.