title: Shoulder arthroplasty for post-traumatic osteonecrosis of the humeral head.
abstract: BACKGROUND
  Osteonecrosis (ON) of the humeral head is a known complication of proximal humeral trauma. Prosthetic replacement may be the last option to treat the associated pain. Depending on the condition of the glenoid, hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) can be considered. To date, the peer reviewed literature offers limited direction on the better treatment for this population.
  
  
  METHODS
  Between 1973 and 2010, 93 arthroplasties were performed for post-traumatic ON of the humeral head after conservative treatments failed. Of these, 37 HAs and 46 TSAs were monitored for a minimum of 2 years (mean, 8.9 years) or until reoperation.
  
  
  RESULTS
  The HA and TSA groups showed improvements in pain (P < .001), elevation (P < .01), and external rotation (P < .01). The TSA group had less pain at follow-up than the HA group (2.1 vs 3.0, P = .001). TSA led to better satisfaction (70% vs 56%) and more excellent/satisfactory Neer ratings (57% vs 41%) compared with HA. Nine HA patients and 5 TSA patients underwent reoperation. The most common causes for reoperation were painful glenoid arthrosis (n = 8) in HA and rotator cuff failure (n = 4) in TSA. The estimated 15-year survivorship was 79.5% for HA and 83% for TSA.
  
  
  CONCLUSIONS
  In patients with post-traumatic ON of the humeral head, shoulder arthroplasty provides improvements in range of motion. However, TSA provides superior pain relief, with better patient-reported satisfaction. TSA should be strongly considered in patients with post-traumatic ON of the humeral head with damage to the glenoid cartilage.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Schoch
authors.affiliation: Department of Orthopedic Surgery, Ohio State University, Columbus, OH, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Barlow
authors.affiliation: Department of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Schleck
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Cofield
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Sperling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; 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 / Q000601:surgery; D010020:Osteonecrosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Total shoulder arthroplasty; hemiarthroplasty; post-traumatic avascular necrosis