Shoulder arthroplasty for atraumatic osteonecrosis of the humeral head.
BACKGROUND
Osteonecrosis (ON) of the humeral head represents <5% of the shoulder arthroplasty population. Depending on the stage of disease, surgeons must decide between hemiarthroplasty (HA) and total shoulder arthroplasty (TSA). To date, the peer-reviewed literature offers minimal insight into the best form of treatment of this population of patients.


METHODS
Between August 1973 and November 2010, 141 shoulder arthroplasties were performed for operatively confirmed ON of the humeral head; 67 HAs and 71 TSAs were observed for at least 2 years (mean, 9.3 years) or until reoperation. Indications for surgery included imaging-confirmed ON in a patient who had failed to respond to conservative treatment modalities.


RESULTS
Shoulder arthroplasty provided significant improvements in pain scores (P < .001), elevation (P < .01), and external rotation (P < .01) for both the HA and TSA populations. Both groups showed similar patient-reported satisfaction (>75%) and excellent/satisfactory Neer ratings (>65%). Eleven percent of HAs had moderate to severe glenoid erosion at follow-up, and 25% of glenoid components were radiographically at risk. Eight HAs and 11 TSAs underwent reoperation. The most common cause for reoperation was painful glenoid arthrosis in the HA group (7) and aseptic loosening (4) in the TSA group. The estimated 20-year survivorship of HA and TSA was 87% and 79%, respectively.


CONCLUSIONS
In patients with atraumatic ON of the humeral head, both HA and TSA can be expected to provide lasting pain relief and improved range of motion, with HA having longer follow-up. HA should be strongly considered in patients with atraumatic ON of the humeral head and preserved glenoid cartilage.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Bradley S
BS
Schoch
Department of Orthopedic Surgery, Ohio State University, Columbus, OH, USA.
Jonathan D
JD
Barlow
Department of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Cathy
C
Schleck
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Robert H
RH
Cofield
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu.
John W
JW
Sperling
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D058430:Humeral Head / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology / Q000601:surgery; D010020:Osteonecrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D012540:Scapula / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
Total shoulder arthroplasty; atraumatic osteonecrosis; hemiarthroplasty