Shoulder arthroplasty for post-traumatic osteonecrosis of the humeral head

Abstract

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. 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. 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. 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.