The Journal of Bone and Joint Surgery (American). 2009;91:340-349.
doi:10.2106/JBJS.H.00560
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Treatment of Osteonecrosis of the Humeral Head with Cementless Surface Replacement Arthroplasty

Patric Raiss, MD1, Philip Kasten, MD, PhD1, Florian Baumann1, Michael Moser1, Markus Rickert, MD, PhD1 and Markus Loew, MD, PhD1

1 Department of Shoulder and Elbow Surgery, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200 A, 69118 Heidelberg, Germany. E-mail address for P. Raiss: Patric.Raiss{at}ok.uni-heidelberg.de

Investigation performed at the Orthopaedic Department, University of Heidelberg, Heidelberg, Germany

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Deutsche Arthrose-Hilfe e.V. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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°). 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.


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