Shoulder hemiarthroplasty for steroid-associated osteonecrosis.
Currently, there is little information on the outcome of humeral head replacement for steroid-associated osteonecrosis of the humeral head. The purpose of this study was to evaluate the outcome of patients who underwent humeral head replacement for steroid-associated osteonecrosis to determine the results, risk factors for an unsatisfactory outcome, and rates of revision surgery. Between 1980 and 2000, 32 shoulder hemiarthroplasties were performed for steroid-associated osteonecrosis. We included 31 hemiarthroplasties in 25 patients with a minimum 2-year follow-up (mean, 12.0 years) in the study. The mean age of the 23 female and 9 male patients was 49.4 years at the time of surgery (range, 25-86 years). Overall, mean pain scores decreased from 4.6 to 2.6 (P < .0001). However, moderate or severe pain was reported in 12 shoulders (38%) at the most recent follow-up, 2 of them requiring implant revision. The mean preoperative to postoperative active elevation increased from 92 degrees to 139 degrees (P < .0001), and external rotation increased from 36 degrees to 65 degrees (P < .0001). According to a modified Neer result rating system, there were 13 excellent results (42%), 4 satisfactory results (13%), and 14 unsatisfactory results (45%). Improvement in pain and function most often occurred after hemiarthroplasty as a treatment for steroid-associated osteonecrosis of the humeral head. However, there are a large number of unsatisfactory results related to glenoid cartilage wear over time.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Robert G
RG
Smith
John W
JW
Sperling
Robert H
RH
Cofield
Steven J
SJ
Hattrup
Cathy D
CD
Schleck
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006811:Humerus; D007595:Joint Prosthesis; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D012086:Reoperation; D012785:Shoulder Joint
D005938:Glucocorticoids