Effectiveness of replacement arthroplasty with calcar grafting and avoidance of greater tuberosity osteotomy for the treatment of humeral surgical neck nonunions

A retrospective review was conducted on 12 patients (mean age, 63 years) undergoing replacement arthroplasty with calcar grafting for humeral surgical neck nonunions. Patients were evaluated preoperatively for pain and range of motion and postoperatively by use of the American Shoulder and Elbow Surgeons and Constant scores. Indications included severe pain, disability humeral head destruction, and inadequate bone stock. Nine patients were available for a mean of 69 months' follow-up. Eight underwent humeral head replacement, and one underwent total shoulder replacement. None required greater tuberosity osteotomy. Previously, open reduction-internal fixation had failed in 2 and closed reduction and percutoneous pinning had failed in 1. Calcar grafts were incorporated in 7 of 9 patients. Postoperative pain was absent in 7 and mild in 2. Mean active forward elevation improved by 64 degrees. Mean active external rotation improved by 45 degrees. Postoperatively, American Shoulder and Elbow Surgeons scores averaged 80 and Constant scores averaged 64. Replacement arthroplasty with calcar grafting is a reliable treatment option for surgical neck nonunions.