Our Summary

The research paper discusses a study that examined 25 patients with 29 affected shoulders who underwent a shoulder replacement surgery due to humeral head avascular necrosis (a condition where the bone in the upper arm near the shoulder dies due to lack of blood supply) between 2004 and 2015. The researchers thought that regardless of the type of implant used, the stage of the disease, or the cause of the disease, patients would experience significant improvement in pain, mobility, and shoulder function after the surgery.

To test this, they looked at patient records that met their study criteria and used various standardized tests to evaluate the outcomes. They examined the results for all patients and also looked at different categories (type of treatment, stage of the disease, and underlying cause).

The results, which were measured an average of 3.9 years after surgery, showed that all patients who underwent the surgery for this condition had significant improvements in function. Those who received a total shoulder replacement had higher scores and greater improvements compared to those who only had a partial replacement. Those with more advanced disease showed similar trends compared to those with less advanced disease. Patients whose condition was caused by trauma had the highest scores in three out of four measures and showed improvement in all scoring methods. However, these differences were not statistically significant. No patients required a second surgery, and minor complications occurred in two patients.

In conclusion, the study found that both total and partial shoulder replacement are safe and effective treatments for patients with this condition, regardless of the cause of the disease or its stage.

FAQs

  1. What is humeral head avascular necrosis (HHAVN) and how is it treated?
  2. What outcomes were measured in the study of patients treated with arthroplasty for HHAVN?
  3. What were the results of the study and how did different factors (such as the type of implant, the stage of the disease, and the cause of the disease) impact these outcomes?

Doctor’s Tip

A helpful tip a doctor might give a patient about shoulder replacement is to follow the post-operative rehabilitation plan diligently. This may include physical therapy exercises to help improve range of motion and strength in the shoulder. It is important to communicate any concerns or pain to your healthcare provider so they can adjust your treatment plan as needed. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support the healing process and improve overall shoulder function.

Suitable For

Patients who are typically recommended for shoulder replacement surgery include those with humeral head avascular necrosis (HHAVN) who have not responded to conservative treatments such as physical therapy, medications, and injections. This study found that both total shoulder arthroplasty (TSA) and hemiarthroplasty were effective in improving pain, range of motion, and shoulder functionality in patients with HHAVN, regardless of the underlying cause or the stage of the disease. Patients with trauma as the underlying cause of HHAVN had the highest scores in outcome measures and favorable changes in functionality.

Overall, shoulder replacement surgery can be a safe and effective treatment option for patients with HHAVN who have not had success with conservative treatments, and can lead to significant improvements in shoulder function and quality of life. It is important for patients to discuss the potential risks and benefits of shoulder replacement surgery with their healthcare provider to determine if it is the right treatment option for their individual situation.

Timeline

Before shoulder replacement:

  • Patient experiences pain and limited range of motion in the affected shoulder
  • Patient may have difficulty performing daily activities and tasks due to shoulder dysfunction
  • Patient undergoes evaluation by a healthcare provider, including imaging studies to determine the extent of damage to the shoulder joint
  • Patient and healthcare provider discuss treatment options, including the possibility of shoulder replacement surgery
  • Patient undergoes pre-operative preparation, which may include physical therapy and medical clearance
  • Patient undergoes shoulder replacement surgery, either total shoulder arthroplasty (TSA) or hemiarthroplasty

After shoulder replacement:

  • Patient experiences initial post-operative pain and swelling, which gradually improves with pain management and physical therapy
  • Patient begins a rehabilitation program to regain strength and range of motion in the shoulder joint
  • Patient attends follow-up appointments with the healthcare provider to monitor progress and address any concerns
  • Patient gradually resumes normal activities and may experience significant improvement in pain, range of motion, and shoulder functionality
  • Patient may continue with ongoing physical therapy and exercise to maintain shoulder function and prevent complications
  • Patient undergoes periodic follow-up evaluations to assess the long-term success of the shoulder replacement and address any potential issues that may arise

What to Ask Your Doctor

  1. What are the different types of shoulder replacement surgeries available for treating humeral head avascular necrosis?
  2. What are the potential risks and complications associated with shoulder replacement surgery for this specific condition?
  3. What is the expected recovery time and rehabilitation process after shoulder replacement surgery for humeral head avascular necrosis?
  4. How long do the results of shoulder replacement surgery typically last for patients with this condition?
  5. Are there any specific lifestyle changes or precautions that need to be taken after shoulder replacement surgery for humeral head avascular necrosis?
  6. What are the success rates and outcomes of shoulder replacement surgery for patients with humeral head avascular necrosis in the short- and long-term?
  7. Can physical therapy or other non-surgical treatments be used in conjunction with shoulder replacement surgery for this condition?
  8. How frequently will follow-up appointments be needed after shoulder replacement surgery for humeral head avascular necrosis?
  9. Are there any specific activities or movements that should be avoided after shoulder replacement surgery for this condition?
  10. Are there any alternative treatments or options available for patients with humeral head avascular necrosis who may not be suitable candidates for shoulder replacement surgery?

Reference

Authors: Ristow JJ, Ellison CM, Mickschl DJ, Berg KC, Haidet KC, Gray JR, Grindel SI. Journal: J Shoulder Elbow Surg. 2019 Jan;28(1):9-14. doi: 10.1016/j.jse.2018.06.031. Epub 2018 Sep 14. PMID: 30224207