Osteonecrosis of the humeral head: Results of replacement

One hundred twenty-seven shoulders treated with replacement arthroplasty fo r osteonecrosis of the humeral head were reviewed and assessed by mailed qu estionnaire for results, durability and complications. These included 71 hu meral head replacements and 56 total shoulder replacements. Thirty-six shou lders were lost to follow-vp because of death of the patient; an additional 3 shoulders were lacking survey follow-vp. Thus current follow-up was avai lable for 88 shoulders. At an average follow-up of 8.9 years, subjective im provement was expressed for 70 (79.5%) of the shoulders and no to occasiona l moderate pain For 68 (77.3%). The mean American Shoulder and Elbow Surgeo n score was 63, and the median was 68. Inferior results in American Shoulde r and Elbow Surgeon score and range of motion were noted in post-traumatic osteonecrosis, and superior results were noted in steroid-induced osteonecr osis. Little difference was found between humeral head replacement and tota l shoulder replacement. The most common postoperative complication was rota tor cuff tearing, found in 23 (18.1%) of 127 shoulders. This complication w as more common in shoulders with a history of any surgery. The cause of ost eonecrosis and previous treatment have important implications for the resul ts of shoulder replacement for this disease.