Osteonecrosis of the humeral head: results of replacement

One hundred twenty-seven shoulders treated with replacement arthroplasty for osteonecrosis of the humeral head were reviewed and assessed by mailed questionnaire for results, durability, and complications. These included 71 humeral head replacements and 56 total shoulder replacements. Thirty-six shoulders were lost to follow-up because of death of the patient; an additional 3 shoulders were locking survey follow-up. Thus current follow-up was available for 88 shoulders. At an average follow-up of 8.9 years, subjective improvement was expressed for 70 (79.5%) of the shoulders and no to occasional moderate pain for 68 (77.3%). The mean American Shoulder and Elbow Surgeon score was 63, and the median was 68. Inferior results in American Shoulder and Elbow Surgeon score and range of motion were noted in post-traumatic osteonecrosis, and superior results were noted in steroid-induced osteonecrosis. Little difference was found between humeral head replacement and total shoulder replacement. The most common postoperative complication was rotator cuff tearing, found in 23 (18.1%) of 127 shoulders. This complication was more common in shoulders with a history of any surgery. The cause of osteonecrosis and previous treatment have important implications for the results of shoulder replacement for this disease.