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      Shoulder Arthroplasty for Humeral Head Avascular Necrosis Is Associated With Increased Postoperative Complications

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          Abstract

          Background

          Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA).

          Questions/Purposes

          The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN.

          Methods

          Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls.

          Results

          The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications.

          Conclusions

          TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s11420-017-9562-8) contains supplementary material, which is available to authorized users.

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          Author and article information

          Contributors
          bcw4x@virginia.edu
          Journal
          HSS J
          HSS J
          HSS Journal
          Springer US (New York )
          1556-3316
          1556-3324
          15 May 2017
          February 2018
          : 14
          : 1
          : 2-8
          Affiliations
          [1 ] ISNI 0000 0000 9081 2336, GRID grid.412590.b, Department of Orthopaedic Surgery, , University of Michigan Health System, ; 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0391 USA
          [2 ] ISNI 0000 0004 1936 9932, GRID grid.412587.d, Department of Orthopaedic Surgery, , University of Virginia Health System, ; PO Box 800159 HSC, Charlottesville, VA 22908 USA
          [3 ] ISNI 0000 0000 9758 5690, GRID grid.5288.7, Oregon Health and Science University, ; 700 S.W. Campus Drive, 7th floor, Portland, OR 97239 USA
          Article
          PMC5786582 PMC5786582 5786582 9562
          10.1007/s11420-017-9562-8
          5786582
          29398987
          3742f184-80e1-40ee-bbee-3841ac74b79e
          © Hospital for Special Surgery 2017
          History
          : 13 December 2016
          : 19 April 2017
          Categories
          Original Article
          Custom metadata
          © Hospital for Special Surgery 2018

          complications,avascular necrosis,infection,total shoulder arthroplasty,revision

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