Late-presenting chronic humeral head collapse, Cruess stage V, managed with modular uncemented hemiarthroplasty

Humeral head osteonecrosis may remain unrecognized until collapse and secondary arthropathy develop. A 44-year-old man presented with progressive right shoulder pain and restricted motion for 1 year. Radiographs and computed tomography showed advanced humeral head collapse with secondary glenohumeral arthropathy, most consistent with Cruess stage V osteonecrosis. Preoperative ultrasound demonstrated preserved rotator cuff continuity. Because joint-preserving procedures were not feasible, modular uncemented shoulder hemiarthroplasty was performed. This case illustrates the rationale for hemiarthroplasty in selected patients with stage V disease when destruction is predominantly humeral-sided, glenoid bone loss is limited, the rotator cuff continuity is preserved, and maintaining future revisionoptions is an important consideration.