Stemless arthroplasty for avascular necrosis of the humerus: implant survival and outcomes

Avascular necrosis (AVN) of the humeral head often affects younger patients and may lead to progressive pain and functional deficits. While stemmed hemiarthroplasty and total shoulder arthroplasty (TSA) are established treatments for advanced-stage AVN, stemless arthroplasty offers potential advantages including bone preservation and facilitation of future revision. However, the impact of bone necrosis on stemless humerus fixation is yet to be elucidated. Therefore, the purpose of this study was to evaluate the outcomes of stemless hemiarthroplasty and TSA in treating humeral head AVN and, further, to determine if stemless humeral fixation is appropriate in this population.

This retrospective case series identified patients treated for humeral head AVN at a single academic medical center between 2013 and 2023. Patients undergoing stemless hemiarthroplasty or stemless TSA with a minimum of 2 years of clinical follow-up were included. Demographic data, operative characteristics, range of motion, Patient-Reported Outcomes Measurement Information System scores, revision surgery, and implant survival were recorded.

Twenty-three patients (27 shoulders) underwent stemless arthroplasty for AVN, including 18 hemiarthroplasties and 9 TSAs. The mean age was 39.7 ± 14.4 years, with a mean follow-up of 4.8 ± 1.9 years. The overall cohort demonstrated increases in mean forward flexion from 129.3° to 151.5°, external rotation from 40.5° to 52.8°, and abduction from 110.8° to 120.0°. Patient-Reported Outcomes Measurement Information System Pain Interference scores improved from 63.43 to 58.84 at final follow-up, Physical Function scores improved from 36.00 to 42.15, and Depression scores improved from 47.86 to 45.50. Two hemiarthroplasty patients required revision surgery, while no TSA patient underwent revision. One unrevised TSA demonstrated radiographic osteolysis with suspected loosening.

Hemiarthroplasty and stemless TSA for humeral head AVN were associated with favorable mid-term outcomes and high implant survival. Stemless arthroplasty may represent a viable treatment option for select patients with humeral head AVN.