Humeral Head Osteonecrosis: Outcomes of Hemiarthroplasty After Minimum 10-Year Follow-Up

Miyazaki, Alberto Naoki; Sella, Guilherme do Val; Silva, Luciana Andrade da; Checchia, Caio Santos; Lemos, Felipe Cerávolo

doi:10.1055/s-0039-3402471

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Original Articles, Shoulder and Elbow • Rev. bras. ortop. 56 (1) • Jan-Feb 2021 • https://doi.org/10.1055/s-0039-3402471 copy

Humeral Head Osteonecrosis: Outcomes of Hemiarthroplasty After Minimum 10-Year Follow-Up^* * Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, Faculty of Medical Sciences of Santa Casa de São Paulo,“Pavilhão Fernandinho Simonsen” (DOT – FCMSCSP) (Director: Prof. Ivan Chakkour, Ph.D).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze long-term functional and radiographic results of partial shoulder replacement for humeral head osteonecrosis.

Methods

Retrospective review of thirteen cases, with a mean postoperative follow-up of 17 years (range 10 to 26 years). The findings from the last follow-up were compared to those in which the patients had one year of postoperative follow-up. Functional assessment consisted of shoulder movement measurements and application of the University of California, Los Angeles (UCLA) shoulder score. All patients underwent radiographic examination to measure glenoid erosion, proximal humeral migration and lateral glenohumeral dislocation.

Results

Glenoid erosion increased over time significantly (p < 0.05). Paradoxically, all active shoulder movements also improved (p < 0.05), while UCLA scores remained the same. Radiographic deterioration was not correlated with clinical function. We had an 84.7% survival rate for arthroplasties after a mean time of 16 years.

Conclusions

Early functional outcomes were maintained in the long run and do not correlate with radiographic deterioration (increased erosion of the glenoid).

Keywords
osteonecrosis; humeral head; follow-up studies

Case	Age (y)	Gender	Dom	Etiology	Neer (stage)	Prosthesis type	Follow-up (y)
1	59	F	-	Posttraumatic	III	Neer II	27
2	73	F	-	Idiopathic	III	Neer II	24
3	74	M	+	Dysbarism	III	Neer II	23
4	57	M	-	Idiopathic	III	Eccentra	20
5	92	F	+	Posttraumatic	IV	Neer II	19
6	68	M	+	Posttraumatic	III	Eccentra	18
7	74	M	-	Posttraumatic	III	Neer II	15
8	62	M	+	Posttraumatic	III	Eccentra	13
9	72	M	-	Posttraumatic	III	Eccentra	13
10	79	F	+	Posttraumatic	IV	Neer II	12
11	42	F	+	Sickle cell anemia	III	Eccentra	12
12	88	F	+	Idiopathic	IV	Neer II	10
13	85	F	+	Posttraumatic	III	Eccentra	10

Mean	PO 1 y	PO 10 y	p-value
Elevation	100º	105º	p > 0.100
External rotation	34º	36º	p > 0.100
Internal rotation	L3	L1	p > 0.100

Grade	PO 1 y n (%)	PO 10 y n (%)
I	01 (08)	-
II	10 (77)	01 (08)
III	01 (08)	09 (69)
IV	01 (08)	03 (23)

	PO 1 y (mm)	PO 10 y (mm)	PO 1 y-PO 10 y (mm)
Lateral glenohumeral offset	67.3	63.6	3.7
Glenohumeral joint space	2.07	1.15	0.92
Glenoid cavity depth	4.1	8.53	-4.38
Proximal migration	4.42	6.31	-1.88
Subacromial space	8.07	5.38	2.69

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Luciana Andrade da Silva, Rua Estuário, 519, Chácara Monte Alegre, São Paulo, SP, 04645-100, Brazil (e-mail: lucalu@terra.com.br).