Shoulder hemiarthroplasty (HA) remains a consideration for patients with evolving or advanced avascular necrosis (AVN) of the humeral head, with or without articular collapse. Reported mid-term outcomes in younger patients undergoing this procedure are limited, and functional and occupational results are largely unknown. The purpose of this study was to evaluate short- to mid-term patient functional outcomes and failure rates among young patients undergoing hemiarthroplasty for humeral head AVN.
Data from patients 40 years or younger who underwent hemiarthroplasty for the treatment of humeral head AVN between December 2008 – January 2018 were retrospectively analyzed. A visual analog scale (VAS) was used for patient reported pain prior to surgery and at follow-up. Additionally, patient functional scores, including the American Shoulder and Elbow Surgeons (ASES) standardized assessment, single assessment numeric evaluation (SANE), Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) and a 5-point Likert scale for subjective patient satisfaction, were collected. A paired T-test was used to compare pre- and postoperative VAS pain scores as well as ASES scores between surgical and non-surgical limbs. Rates of revision surgery were also evaluated.
Of the 12 shoulders identified, 8 (66.7%) shoulders were included in the final analysis, with a mean age and follow-up of 31.4+8.9 and 6.6+3.6 years, respectively. There was a statistically significant improvement in VAS pain scores over the follow-up period (8.9+1.2 vs 4.0+3.2, p=0.001). Comparison of surgical and non-surgical limbs postoperative function did not show any statistically significant differences between SANE scores (70.7+27.8 vs 82.4+22.4; p=0.402) or ASES score averages (69.3+28.5 vs 76.1+25.9; p=0.625). There were no cases of additional surgery or revision arthroplasty at a mean follow up of 6.6 + 3.6 years. 25% of patients expressed dissatisfaction at their final follow-up evaluation.
Patients under the age of 40 years undergoing hemiarthroplasty for the treatment of humeral head AVN can expect low rates of secondary reoperation or revision surgery at 5-10 years postoperatively. Although seven of eight shoulders experienced pain improvement, one in four replacements yielded subjective dissatisfaction at final follow-up, warranting future evaluation regarding patient expectations and their correlation to patient satisfaction.