Clinical and radiological results of shoulder arthroplasty for humeral head osteonecrosis

The purpose of this retrospective muticenter study is to report clin icalresults in a series of shoulder arthroplasties for the treatment ofosteonecrosis of the humeral head.Eighty shoulders undergoing arthrosplasty (26 total shoulder arthroplastiesand 54 hemiarthroplasties in 74 patients,) for atraumaticosteonecrosis, were evaluated with the Constant score and stagedradiographically.With a 41-month follow-up, the adjusted Constant score increasedfrom a mean 37 % to a mean 88%.This study confirms the previously published good results of shoulderarthroplasty in the treatment of osteonecrosis of the humeralhead.For stage V, the best results are observed with total shoulder arthroplasty.For stage II and III, hemiarthroplasty seems to be the bestchoice. For stage IV, the choice is not so easy and age, act ivitiesand status of rotator cuff have to be considered. The authors haveidentified a stage VI: shoulders with collapse of the humeral headcombined with medialisation of the humerus relative to the glenoid.This stage has a faster evolution in older pat ient with respect of theglenoid and an intact rotator cuff, a total shoulder arthroplasty appearsthe best choice for this bad prognostic factor.