TITLE

Treatment of Osteonecrosis of the Humeral Head with Cementless Surface Replacement Arthroplasty

AUTHOR(S)
Raiss, Patric; Kasten, Philip; Baumann, Florian; Moser, Michael; Rickert, Markus; Loew, Markus
PUB. DATE
February 2009
SOURCE
Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p340
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Osteonecrosis of the humeral head is a disabling condition that can lead to joint destruction with persistent pain and dysfunction. The aim of the present study was to examine cementless humeral surface replacement arthroplasty as a treatment option for posttraumatic and nontraumatic osteonecrosis. Methods: Between 2002 and 2005, seventeen shoulders with posttraumatic (n = 8) or nontraumatic (n = 9) osteonecrosis of the humeral head were treated with cementless humeral replacement arthroplasty. The mean proportion of the humeral head that was occupied by necrotic bone was 18.6% (range, 8.9% to 30.9%). The mean duration of follow-up was three years. Constant scores, patient satisfaction, and complications were recorded. Volumetric measurements of the necrotic areas and signs of implant loosening were analyzed with use of standardized radiographs. Results: The mean Constant score for the entire cohort improved significantly from 31 to 62 points (34% to 75% when adjusted by age and sex) (p < 0.0001). There were also significant improvements in mean shoulder flexion (from 87° to 139°), abduction (from 64° to 120°), and external rotation (from 2° to 27#x00B0;). The final values for the Constant score, abduction, and power were significantly higher for the nontraumatic group than for the posttraumatic group. Fourteen patients (fifteen shoulders) were very satisfied (eleven shoulders) or satisfied (four shoulders), and two patients (two shoulders) were somewhat disappointed with the postoperative result. Signs of implant loosening were not observed. One patient had a wound infection that required surgical débridement and antibiotic therapy. To date, no implant revisions have been necessary. Conclusions: Cementless humeral surface replacement arthroplasty is a potentially bone-preserving option for patients with posttraumatic and nontraumatic osteonecrosis of the humeral head. Even in the presence of bone loss of as much as 31% of the humeral head, implant loosening was not observed. Good functional results and relief of pain in combination with a low complication rate can be achieved in the short term. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
36627714

 

Related Articles

  • Expanded indications to lead next phase in reverse shoulder arthroplasty concept. Blazek, Nicole // Orthopaedics Today Europe;Jul/Aug2011, Vol. 14 Issue 4, p1 

    The article focuses on the increasing popularity of reverse shoulder arthroplasty as an innovative shoulder procedure for restoring motion and relieving pain in patients with shoulder injuries.

  • Shoulder Arthroplasty in Patients with a Prior Anterior Shoulder Dislocation. Matsoukis, J.; Tabib, W.; Guiffault, P.; Mandelbaum, A.; Walch, Gilles; Nemoz, Chantal; Edwards, T. Bradley // Journal of Bone & Joint Surgery, American Volume;Aug2003, Vol. 85-A Issue 8, p1417 

    Reports results of shoulder arthroplasty in all patients with a prior anterior shoulder dislocation, including both those previously treated operatively and those previously treated nonoperatively. Measures used to evaluate shoulders; Differences observed between the patients treated with a...

  • Medial unicompartimental knee arthroplasty for osteonecrosis or osteoarthritis. Servien, E.; Verdonk, P.; Lustig, S.; Paillot, J.; Kara, A.; Neyret, P. // Knee Surgery, Sports Traumatology, Arthroscopy;Nov2008, Vol. 16 Issue 11, p1038 

    We report a prospective series of 33 unicompartmental knee arthroplasties (UKAs) operated for a spontaneous osteonecrosis of the knee (SPONK) compared with 35 UKAs operated for osteoarthritis (OA). The mean follow-up was 5 years. Preoperative functional score in the SPONK group was significantly...

  • Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction. Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio; Giordano, Giovanni; Bonanzinga, Tommaso; Grassi, Alberto; Nitri, Marco; Bruni, Danilo; Ravazzolo, Giovanni; Marcacci, Maurilio // Knee Surgery, Sports Traumatology, Arthroscopy;May2012, Vol. 20 Issue 5, p816 

    Purpose: The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher...

  • Surgical Technique: The Anterosuperior Approach for Reverse Shoulder Arthroplasty. Molé, Daniel; Wein, Frank; Dézaly, Charles; Valenti, Philippe; Sirveaux, François // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2461 

    Background: The anterosuperior approach used for reverse shoulder arthroplasty is an intermediate between the transacromial approach originally proposed by Paul Grammont and the anterosuperior approach described by D. B. Mackenzie for shoulder arthroplasty. As an alternative to the deltopectoral...

  • A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties. Kempton, Laurence; Ankerson, Elizabeth; Wiater, J. // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2496 

    Background: Reported early complication rates in reverse total shoulder arthroplasty have widely varied from 0% to 75% in part due to a lack of standard inclusion criteria. In addition, it is unclear whether revision arthroplasty is associated with a higher rate of complications than primary...

  • Scapular Notching in Reverse Shoulder Arthroplasty: Is It Important to Avoid It and How? Lévigne, Christophe; Garret, Jérome; Boileau, Pascal; Alami, Ghassan; Favard, Luc; Walch, Gilles // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2512 

    Background: Scapular notching, erosion of the scapular neck related to impingement by the medial rim of the humeral cup during adduction, is a radiographic sign specific to reverse shoulder arthroplasty (RSA). Its clinical and radiological consequences remain unclear. Questions/purposes:...

  • Is Reverse Shoulder Arthroplasty a Reasonable Alternative for Revision Arthroplasty? Austin, Luke; Zmistowski, Benjamin; Chang, Edward; Williams, Gerald // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2531 

    Background: Reverse shoulder arthroplasty (RSA) improves function in selected patients with complex shoulder problems. However, we presume patient function would vary if performed primarily or for revision and would vary with other patient-specific factors. Questions/purposes: We compared (1)...

  • Can Reverse Shoulder Arthroplasty be Used with Few Complications in Rheumatoid Arthritis? Ekelund, Anders; Nyberg, Ragnhild // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2483 

    Background: Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics