Outcomes of shoulder replacement in humeral head avascular necrosis. J Shoulder Elbow Surg 2019 Jan;28(1):9-14
Date
09/19/2018Pubmed ID
30224207DOI
10.1016/j.jse.2018.06.031Scopus ID
2-s2.0-85053179815 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
BACKGROUND: This retrospective review evaluated 25 patients with 29 shoulders treated with arthroplasty for humeral head avascular necrosis (HHAVN) between 2004 and 2015. We hypothesized that regardless of implant, radiographic stage, or etiology, patients would appreciate significant improvement in pain, range of motion, and shoulder functionality after surgical intervention.
METHODS: Data were obtained by record review on all patients meeting inclusion criteria. Outcomes were evaluated using Simple Shoulder Test, Modified Constant Score, University of California Los Angeles Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The data were assessed by all patients and subcategories (treatment, avascular necrosis stage, and underlying cause).
RESULTS: At a mean follow-up of 3.9 years (range, 1-8.5 years), all patients who underwent operative intervention for HHAVN showed statistically significant improvement in functionality measurements (P < .01). Patients who underwent total shoulder arthroplasty (TSA) noted higher median outcome scores and greater improvement in all scoring methods compared with their hemiarthroplasty counterparts. The high-stage disease shoulders showed similar trends over low-stage counterparts. The shoulders in the trauma causal group had the highest scores in 3 of 4 outcome measures and favorable change in all scoring methods. These differences were not statistically significant (P > .05). No revision arthroplasties were required. Minor complications (suture abscess and intraoperative calcar fracture requiring cabling) occurred in 2 TSA patients.
CONCLUSIONS: Our outcomes demonstrate that in the short- to midterm follow-up, TSA or hemiarthroplasty is a safe and equally effective treatment for patients diagnosed with HHAVN regardless of etiology and radiographic staging.
Author List
Ristow JJ, Ellison CM, Mickschl DJ, Berg KC, Haidet KC, Gray JR, Grindel SIAuthors
Ciani M. Ellison MD Assistant Professor in the Radiation Oncology department at Medical College of WisconsinSteven I. Grindel MD Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Arthroplasty, Replacement, Shoulder
Female
Humans
Humeral Head
Male
Middle Aged
Osteonecrosis
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Young Adult
