Shoulder hemi-arthroplasty for humeral head avascular necrosis

The following case is a middle aged patient with shoulder pain for several years. The radiographic evaluation of the shoulder demonstrated post-collapse avascular necrosis of the humeral head. The cause of his disease was alcohol abuse. While some surgeons believe that a "minimallly invasive" procedure is appropriate for the treatment of this condition we avoid the use of such procedures because:
(1) mini caps have the problem of loosening and do not prevent further progression of the disease

(2) shoulder resurfacing implants result in early loosening and revision to hemi-arthroplasties.

The longevity of a hemi-arthroplasty is approximately 10 years before glenoid wear becomes an issue. At that point a conversion of the hemi-arthroplasty to a total shoulder replacement can be offered extending the longevity to an additional 10-15 years.  Preop/postop radiographs and intraoperative images are shown below

Severe loss of cartilage from AVN