Work

Long-term outcomes of hemiarthroplasty and anatomic total shoulder arthroplasty for atraumatic humeral head avascular necrosis

Year: 2026

Type: article

Abstract: Background: Avascular necrosis (AVN) of the humeral head arises from diverse etiologies, yet comparative outcome data across etiologic subgroups remain limited. This study evaluated whether AVN etiology influences functional recovery, implant survival, and mortality following shoulder arthroplasty. Methods: We conducted a retrospective review of arthroplasty cases for primary atraumatic humeral head AVN performed between 2003 and 2023. Patients who underwent total shoulder arthroplasty, hemiarthroplasty, humeral head resurfacing, or partial humeral head resurfacing were included. Revision-free survival and overall survival were evaluated with Kaplan-Meier analysis, and predictors of mortality were assessed with multivariable binary logistic regression. American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, and range of motion (ROM) data were compared in shoulders with at least 1 year of follow-up using linear mixed-effects models. A post hoc Cruess grade sensitivity analysis was performed in shoulders with adequate pre-operative radiographs by 2 blinded graders. Results: = .889 and .773). Conclusion: In this cohort, idiopathic AVN demonstrated more rapid improvement in patient-reported outcomes and ROM over time despite worse modeled baseline function. This patient-reported outcome finding derives from an exploratory subgroup (n = 31) and is hypothesis-generating. With only 5 revision events, revision comparisons should be interpreted cautiously. In contrast, mortality was associated with overall comorbidity burden, with pre-operative American Society of Anesthesiologists status the only significant predictor of long-term survival.

Source: Journal of Shoulder and Elbow Arthroplasty

DOI: 10.1016/j.jsea.2026.100093