Long-term outcomes of hemiarthroplasty and anatomic total shoulder arthroplasty for atraumatic humeral head avascular necrosis
5 affiliations
- 1University of South Florida, Morsani College of Medicine, Tampa, FL, USA
- 2Florida Orthopaedic Institute, Shoulder Service, Tampa, FL, USA
- 3Department of Orthopaedic Surgery and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- 4Foundation for Orthopaedic Research and Education, Department of Translational Research, Tampa, FL, USA
- 5Department of Orthopaedic Surgery, Tampa General Hospital, Tampa, FL, USA
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
Of 51 shoulders in 42 patients, 60.8% were female, and the mean age at surgery was 55.1 ± 11.5 years. Five revisions (9.8%) occurred. Kaplan-Meier revision-free survivorship was 90.2% at 5 years and 82.0% at 10 years, with no significant differences by procedure type or AVN etiology. Overall patient survival was 79.7% at 10 years and 75.9% at 15 years. Pre-operative American Society of Anesthesiologists physical status was the only variable significantly associated with mortality after adjustment for age, sex, procedure group, and etiology group (odds ratio, 13.47 per 1-point increase; 95% CI, 1.65-110.15; P = .015; the wide confidence interval reflects the small number of deaths and complete separation, and this estimate should be regarded as imprecise). In the patient-reported outcome measure subgroup (n = 31), idiopathic AVN cases had lower modeled baseline ASES scores but faster improvement over time in ASES, Simple Shoulder Test, and multiple ROM outcomes than known-etiology cases (n = 19). A Cruess grade sensitivity analysis (n = 43) showed no difference in radiographic stage between groups by either blinded grader (P = .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.
Related
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- Stemmed versus stemless humeral implants in anatomic total shoulder arthroplasty: a systematic review and meta-analysis.
- Asymmetric reaming compared to posterior augmented components for posterior glenoid wear and retroversion in anatomic total shoulder arthroplasty: a minimum ten-year follow-up outcome analysis
BibTeX
@article{cohen2026longterm,
title = {{Long-term outcomes of hemiarthroplasty and anatomic total shoulder arthroplasty for atraumatic humeral head avascular necrosis}},
author = {Eric M. Cohen and William A. Ranson and Michael P. Kucharik and Conrad Stoy and Kaitlyn N. Christmas and Peter Simon and Mark A. Frankle},
journal = {Journal of shoulder and elbow arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100093},
url = {https://europepmc.org/article/PMC/PMC13718849},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Long-term outcomes of hemiarthroplasty and anatomic total shoulder arthroplasty for atraumatic humeral head avascular necrosis
AU - Eric M. Cohen
AU - William A. Ranson
AU - Michael P. Kucharik
AU - Conrad Stoy
AU - Kaitlyn N. Christmas
AU - Peter Simon
AU - Mark A. Frankle
PY - 2026
DA - 2026/09/23
JO - Journal of shoulder and elbow arthroplasty
DO - 10.1016/j.jsea.2026.100093
UR - https://europepmc.org/article/PMC/PMC13718849
AB - 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 Of 51 shoulders in 42 patients, 60.8% were female, and the mean age at surgery was 55.1 ± 11.5 years. Five revisions (9.8%) occurred. Kaplan-Meier revision-free survivorship was 90.2% at 5 years and 82.0% at 10 years, with no significant differences by procedure type or AVN etiology. Overall patient survival was 79.7% at 10 years and 75.9% at 15 years. Pre-operative American Society of Anesthesiologists physical status was the only variable significantly associated with mortality after adjustment for age, sex, procedure group, and etiology group (odds ratio, 13.47 per 1-point increase; 95% CI, 1.65-110.15; P = .015; the wide confidence interval reflects the small number of deaths and complete separation, and this estimate should be regarded as imprecise). In the patient-reported outcome measure subgroup (n = 31), idiopathic AVN cases had lower modeled baseline ASES scores but faster improvement over time in ASES, Simple Shoulder Test, and multiple ROM outcomes than known-etiology cases (n = 19). A Cruess grade sensitivity analysis (n = 43) showed no difference in radiographic stage between groups by either blinded grader (P = .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.
SN - 2471-5492
ER -