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Vol. 27, Art. 21 (pp. 507-533)    |    2026       

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Comparative analysis of the use of individual single-pole shoulder joint replacement and total humerus replacement in aseptic necrosis of the proximal humerus (Literature review)

Khudoshin I.A., Nikolaenko A.N., Borisov A.P.

Federal State Budgetary Educational Institution of Higher Medical Education Samara State Medical University of the Ministry of Health of the Russian Federation

Brief summary

Avascular necrosis of the humeral head is a pathological process that leads to progressive necrosis of bone structures due to insufficient blood supply. This condition is associated with the development of severe pain syndrome and persistent limitation of joint function. Timely diagnosis is a key condition for preventing deformity and collapse of articular surfaces, which directly determines the success of further treatment. The relevance is due to the high medical and social significance of this pathology, as well as the emergence of new therapeutic strategies, including replacement of the humerus head with an individual single-pole endoprosthesis. The aim of the work. to conduct a comprehensive comparative analysis (clinical, radiological, functional and economic) of the outcomes of standardized and personalized endoprosthetics in aseptic necrosis of the humerus head. To study the prospects for the development of additive technologies in the context of partial (hemiarthroplasty) and total shoulder arthroplasty, including the creation of integrated (monoblock) structures, implants with osseointegration zones (trabecular coatings) and bioresorbable scaffolds. Materials and methods. the research methodology included a systematic search in the databases PubMed, Cochrane and Google Scholar, CyberLeninka for the period from 2015 to 2025. The endpoints compared were: the frequency of complications and revisions, a subjective assessment of function on the ASES scale, as well as objective parameters of joint mobility - active forward bending, external and internal rotation. The quality of the included studies was assessed using the criteria of the Methodological Index for Non-randomized Studies. Results. This review systematizes current data on therapeutic approaches for avascular necrosis of the humeral head. A personalized approach to endoprosthetics increases the effectiveness of treatment due to: maximum anatomical congruence of individually designed implants; simplifying and improving the accuracy of surgical techniques using patient-specific templates; increasing economic feasibility through the development of additive technologies and process optimization; using biocompatible materials (such as zirconium dioxide), characterized by high wear resistance and minimal reactivity. Conclusion. For young and active patients with avascular necrosis of the humerus head and preserved articular cavity, hemiarthroplasty is the preferred primary method of surgical treatment, providing excellent functional results with maximum preservation of anatomy and minimal long-term risk of complications. Total arthroplasty is recommended for cases with concomitant significant glenoid lesion.


Key words

avascular necrosis of the humerus head; unipolar arthroplasty; total arthroplasty; osteonecrosis

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