Posttraumatic avascular humeral head necrosis may require salvage shoulder arthroplasty in symptomatic cases. We tested the hypothesis that associated tuberosity malunion negatively influences the final clinical outcome after shoulder arthroplasty. Thirty-eight patients with posttraumatic avascular necrosis of the humeral head were followed clinically and radiographically for a minimum of 5 years (mean, 8 years; range, 5-13 years). To quantify preoperative tuberosity malunion, two novel radiographic parameters were introduced: on the anteroposterior view, the greater tuberosity offset as a measurement of lateralization of the greater tuberosity; and on the axillary view, the posterior offset to quantify the degree of widening at the intertubercular groove. At last followup, the average Constant and Murley score had improved from 27 points preoperatively to 57 points postoperatively; shoulder range of motion had increased from 40° abduction to 116°, flexion from 45° to 120°, and external rotation from 15° to 39°. Functional improvements and pain relief were substantial. A significant correlation was found between greater tuberosity offset and posterior offset and final clinical outcome. Preoperative near anatomic tuberosity alignment was associated with good results. The greater tuberosity offset and posterior offset are useful and reliable radiographic predictors of outcome.
Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
From the *Department of Traumatology and Sports Injuries, University Hospital Salzburg, Salzburg, Austria; and the ‡Department of Orthopaedic Surgery, University of Louisville, Louisville, KY.
Received: January 12, 2007 Revised: June 18, 2007 Accepted: August 29, 2007
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Correspondence to: Mark Tauber, MD, Department of Traumatology, University Hospital of Salzburg, Müllner Hauptstr 48, 5020 Salzburg, Austria. Phone: 0043-662-4482-57276; Fax: 0043-662-4482-55008; E-mail: m.tauber@salk.at.
