Outcomes of shoulder replacement in humeral head avascular necrosis.

BACKGROUND: This retrospective review evaluated 25 patients with 29 shoulders treated with arthroplasty for humeral head avascular necrosis (HHAVN) between 2004 and 2015. We hypothesized that regardless of implant, radiographic stage, or etiology, patients would appreciate significant improvement in pain, range of motion, and shoulder functionality after surgical intervention. METHODS: Data were obtained by record review on all patients meeting inclusion criteria. Outcomes were evaluated using Simple Shoulder Test, Modified Constant Score, University of California Los Angeles Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The data were assessed by all patients and subcategories (treatment, avascular necrosis stage, and underlying cause). RESULTS: At a mean follow-up of 3.9 years (range, 1-8.5 years), all patients who underwent operative intervention for HHAVN showed statistically significant improvement in functionality measurements (P < .01). Patients who underwent total shoulder arthroplasty (TSA) noted higher median outcome scores and greater improvement in all scoring methods compared with their hemiarthroplasty counterparts. The high-stage disease shoulders showed similar trends over low-stage counterparts. The shoulders in the trauma causal group had the highest scores in 3 of 4 outcome measures and favorable change in all scoring methods. These differences were not statistically significant (P > .05). No revision arthroplasties were required. Minor complications (suture abscess and intraoperative calcar fracture requiring cabling) occurred in 2 TSA patients. CONCLUSIONS: Our outcomes demonstrate that in the short- to midterm follow-up, TSA or hemiarthroplasty is a safe and equally effective treatment for patients diagnosed with HHAVN regardless of etiology and radiographic staging.

Hematogenous Calcaneal Osteomyelitis in Children.

Osteomyelitis in children commonly affects long bones such as the femur, tibia, and humerus. There have been relatively few documented studies of osteomyelitis at unusual locations, such as the calcaneus. The objective of this study is to systematically review information on the diagnostic and treatment methods of calcaneal osteomyelitis as well as associated complications. Methods included research database searches using primarily PubMed and EMBASE databases. Results of the review show no clear approach to diagnosis and treatment of calcaneal osteomyelitis in children. Clinical presentation of refusal to bear weight was the most common clinical symptom. Magnetic resonance imaging was 100% diagnostic in studies that used this modality, compared with X-rays, which were 14%-71.4% diagnostic. Blood cultures were diagnostic in 27% to 55% of cases, and erythrocyte sedimentation rate was elevated in 79% to 97% of cases. Methicillin-sensitive Staphylococcus aureus was the most common cultured organism. Treatment involved either antibiotics alone or in combination with surgical debridement/evacuation. Penicillin, penicillin derivatives, cephalosporins, clindamycin, and chloramphenicol were the most commonly used antibiotics, with duration varying from 5 days to 10 weeks. The most common complication was recurrent osteomyelitis. LEVELS OF EVIDENCE: III.