Elsevier

Journal of Shoulder and Elbow Surgery

Volume 17, Issue 5, September–October 2008, Pages 689-694
Journal of Shoulder and Elbow Surgery

Original Article
Hemiarthroplasty and total shoulder arthroplasty for avascular necrosis of the humeral head

https://doi.org/10.1016/j.jse.2008.03.009Get rights and content

The purpose of this study was to review the outcome of patients with osteonecrosis of the humeral head, based on etiology and treatment with either hemiarthroplasty or total shoulder arthroplasty (TSA). Sixty-four shoulders, with an average age of 57 years, were evaluated at a mean of 4.8 years. Outcomes included L'Insalata and American Shoulder and Elbow Surgeons (ASES) scores, as well as range of motion (ROM). The overall ASES score was 67, average flexion was 127°, and external rotation was 49°. Outcomes did not differ based on etiology, but ROM was decreased with post-traumatic osteonecrosis. There was no difference in outcome or ROM between hemiarthroplasty and TSA. The complication rate was significantly higher with TSA (22%) than with hemiarthroplasty (8%). Achieving ROM in patients with post-traumatic osteonecrosis remains difficult. TSA was associated with a higher complication rate and decreased mobility and should be reserved for patients with stage V osteonecrosis.

Section snippets

Materials and methods

A retrospective study was performed following approval from the institutional review board. From 1989 to 1997, a total of 845 shoulder arthroplasties were performed. Eighty-four were for osteonecrosis. There were 64 patients, treated by 4 surgeons, who were available for this study. The remaining 20 were lost to follow-up. The 64 were reviewed at a mean of 4.8 years (range, 2-7.2). There were 38 men and 26 women. The mean age at the time of surgery was 57 years (range, 46-77 years).

The most

Results

There were 64 shoulders with a mean age of 57 years of age. The average follow-up was 4.8 years. The average ASES score was 67 ± 6.2 and the average L'Insalata score was 64.7 ± 5.9. The average flexion was 127 ± 12.0°, external rotation was 49 ± 3.9°, and internal rotation was to L1. All but one patient was satisfied with their surgery and would have the surgery again.

There was no statistical difference in ASES and L'Insalata scores based on etiology of osteonecrosis (Table II). Sickle cell

Discussion

Shoulder arthroplasty is a reliable treatment for primary osteoarthritis, as well as rheumatoid arthritis, post-traumatic arthritis, and osteonecrosis.13, 25, 26 Osteonecrosis accounts for approximately 5% of all shoulder arthroplasties performed. However, there have been relatively few studies that evaluate the outcomes following arthroplasty for osteonecrosis of the humeral head, and many of them have few cases or only short-term follow-up.1, 4, 9, 12, 17 As patients with osteonecrosis tend

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