Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head

Justin C. Kennon, Jeffrey P. Smith, Lynn A Crosby

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results. Methods We evaluate radiographic and functional outcomes after procedures for humeral head atraumatic avascular necrosis (HAAVN), decompression efficacy in CSI and SCD populations, and report outcomes of advanced disease requiring arthroplasty. Twenty-five shoulders were treated surgically for HAAVN. Post-traumatic AVN patients were excluded. Stage I/II disease received core decompression and ultrasound bone stimulation. Stage III received surface replacement or hemiarthroplasty, and arthroplasty was performed for stage IV/V. Radiographs and clinical scores were recorded preoperatively and postoperatively. Results Included were 25 HAAVN shoulders (13 SCD and 12 CSI). Eleven shoulders (stage I/II disease) underwent core decompression. Seven of 8 shoulders (88%) progressed to stage III/IV after decompression. All SCD patients progressed to collapse. The procedure in 19 shoulders was surface replacement, hemiarthroplasty, or TSA. Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test-12, and University of California Los Angeles Shoulder scores were significantly higher at 1- and 2-year follow-up with arthroplasty; 13 of 16 arthroplasty patients (81%) had satisfactory to excellent results. One surface replacement was revised to reverse TSA. Conclusions Results suggest core decompression for AVN in SCD patients does not alter osteonecrosis progression and humeral head collapse. Resurfacing and hemiarthroplasty are viable treatment options for stage III, whereas shoulder replacement for stage IV/V disease appears to offer better functional results.

Original languageEnglish (US)
Pages (from-to)1442-1448
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Humeral Head
Osteonecrosis
Decompression
Arthroplasty
Hemiarthroplasty
Sickle Cell Anemia
Necrosis
Steroids
Head
Los Angeles
Elbow
Chronic Disease

Keywords

  • AVN
  • arthroplasty
  • core decompression
  • humeral head
  • humerus
  • osteonecrosis
  • sickle cell

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. / Kennon, Justin C.; Smith, Jeffrey P.; Crosby, Lynn A.

In: Journal of Shoulder and Elbow Surgery, Vol. 25, No. 9, 01.09.2016, p. 1442-1448.

Research output: Contribution to journalArticle

Kennon, Justin C. ; Smith, Jeffrey P. ; Crosby, Lynn A. / Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. In: Journal of Shoulder and Elbow Surgery. 2016 ; Vol. 25, No. 9. pp. 1442-1448.
@article{5c912db3c94b4897b06df456147cbdbe,
title = "Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head",
abstract = "Background Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results. Methods We evaluate radiographic and functional outcomes after procedures for humeral head atraumatic avascular necrosis (HAAVN), decompression efficacy in CSI and SCD populations, and report outcomes of advanced disease requiring arthroplasty. Twenty-five shoulders were treated surgically for HAAVN. Post-traumatic AVN patients were excluded. Stage I/II disease received core decompression and ultrasound bone stimulation. Stage III received surface replacement or hemiarthroplasty, and arthroplasty was performed for stage IV/V. Radiographs and clinical scores were recorded preoperatively and postoperatively. Results Included were 25 HAAVN shoulders (13 SCD and 12 CSI). Eleven shoulders (stage I/II disease) underwent core decompression. Seven of 8 shoulders (88{\%}) progressed to stage III/IV after decompression. All SCD patients progressed to collapse. The procedure in 19 shoulders was surface replacement, hemiarthroplasty, or TSA. Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test-12, and University of California Los Angeles Shoulder scores were significantly higher at 1- and 2-year follow-up with arthroplasty; 13 of 16 arthroplasty patients (81{\%}) had satisfactory to excellent results. One surface replacement was revised to reverse TSA. Conclusions Results suggest core decompression for AVN in SCD patients does not alter osteonecrosis progression and humeral head collapse. Resurfacing and hemiarthroplasty are viable treatment options for stage III, whereas shoulder replacement for stage IV/V disease appears to offer better functional results.",
keywords = "AVN, arthroplasty, core decompression, humeral head, humerus, osteonecrosis, sickle cell",
author = "Kennon, {Justin C.} and Smith, {Jeffrey P.} and Crosby, {Lynn A}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.jse.2016.01.022",
language = "English (US)",
volume = "25",
pages = "1442--1448",
journal = "Journal of Shoulder and Elbow Surgery",
issn = "1058-2746",
publisher = "Mosby Inc.",
number = "9",

}

TY - JOUR

T1 - Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head

AU - Kennon, Justin C.

AU - Smith, Jeffrey P.

AU - Crosby, Lynn A

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results. Methods We evaluate radiographic and functional outcomes after procedures for humeral head atraumatic avascular necrosis (HAAVN), decompression efficacy in CSI and SCD populations, and report outcomes of advanced disease requiring arthroplasty. Twenty-five shoulders were treated surgically for HAAVN. Post-traumatic AVN patients were excluded. Stage I/II disease received core decompression and ultrasound bone stimulation. Stage III received surface replacement or hemiarthroplasty, and arthroplasty was performed for stage IV/V. Radiographs and clinical scores were recorded preoperatively and postoperatively. Results Included were 25 HAAVN shoulders (13 SCD and 12 CSI). Eleven shoulders (stage I/II disease) underwent core decompression. Seven of 8 shoulders (88%) progressed to stage III/IV after decompression. All SCD patients progressed to collapse. The procedure in 19 shoulders was surface replacement, hemiarthroplasty, or TSA. Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test-12, and University of California Los Angeles Shoulder scores were significantly higher at 1- and 2-year follow-up with arthroplasty; 13 of 16 arthroplasty patients (81%) had satisfactory to excellent results. One surface replacement was revised to reverse TSA. Conclusions Results suggest core decompression for AVN in SCD patients does not alter osteonecrosis progression and humeral head collapse. Resurfacing and hemiarthroplasty are viable treatment options for stage III, whereas shoulder replacement for stage IV/V disease appears to offer better functional results.

AB - Background Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results. Methods We evaluate radiographic and functional outcomes after procedures for humeral head atraumatic avascular necrosis (HAAVN), decompression efficacy in CSI and SCD populations, and report outcomes of advanced disease requiring arthroplasty. Twenty-five shoulders were treated surgically for HAAVN. Post-traumatic AVN patients were excluded. Stage I/II disease received core decompression and ultrasound bone stimulation. Stage III received surface replacement or hemiarthroplasty, and arthroplasty was performed for stage IV/V. Radiographs and clinical scores were recorded preoperatively and postoperatively. Results Included were 25 HAAVN shoulders (13 SCD and 12 CSI). Eleven shoulders (stage I/II disease) underwent core decompression. Seven of 8 shoulders (88%) progressed to stage III/IV after decompression. All SCD patients progressed to collapse. The procedure in 19 shoulders was surface replacement, hemiarthroplasty, or TSA. Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test-12, and University of California Los Angeles Shoulder scores were significantly higher at 1- and 2-year follow-up with arthroplasty; 13 of 16 arthroplasty patients (81%) had satisfactory to excellent results. One surface replacement was revised to reverse TSA. Conclusions Results suggest core decompression for AVN in SCD patients does not alter osteonecrosis progression and humeral head collapse. Resurfacing and hemiarthroplasty are viable treatment options for stage III, whereas shoulder replacement for stage IV/V disease appears to offer better functional results.

KW - AVN

KW - arthroplasty

KW - core decompression

KW - humeral head

KW - humerus

KW - osteonecrosis

KW - sickle cell

UR - http://www.scopus.com/inward/record.url?scp=84964389119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964389119&partnerID=8YFLogxK

U2 - 10.1016/j.jse.2016.01.022

DO - 10.1016/j.jse.2016.01.022

M3 - Article

VL - 25

SP - 1442

EP - 1448

JO - Journal of Shoulder and Elbow Surgery

JF - Journal of Shoulder and Elbow Surgery

SN - 1058-2746

IS - 9

ER -