Results of shoulder replacement in nonunions of the surgical neck of the proximal humerus
Authors: O Leger et al.
References: Presented at AAOS 2003
Introduction: We evaluated results of the treatment of nonunions of the surgical neck of the proximal humerus with a shoulder prosthesis. Material and methods : Twenty-two patients, mean age 70 years, underwent shoulder arthroplasty for a surgical neck nonunion (21 HHR and 1 TSA). Initial fracture was two-part in 6 cases, 3-part in 13 and 4-part in 3. Initial treament was conservative in 10 cases and surgical in 12. A deltopectoral approach was used, and tuberosity osteotomy and osteosynthesis were needed in all cases. All patients were evaluated clinically and radiographically with minimum 2 year follow-up. Results : Mean Constant score increased from 23 points pre-operatively to 39 post-operatively, mean active anterior elevation from 53° to 63°, average pain from 3 points to 9, and mean external rotation from 13° to 28° (p<0.01 for all parameters). Initial fracture, initial type of treatment and delay between fracture and prosthesis had no influence on final outcome. Complications occurred in 8 cases (36%): radiographic persistence of the non-union (6), proximal migration of the prosthesis (1), and humeral loosening (1) Conclusion : Functional results of shoulder replacement for nonunions of the surgical neck are poor. Almost no functional benefit, despite statistical significance, is demonstrated for anterior elevation, strength, or activity. However, pain relief appears to be substantial. We conclude that shoulder replacement for nonunions of the surgical neck of the proximal humerus should be considered a "limited goals" procedure and may not be the most appropriate form of treatment to restore functional status.