Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Core decompression for early-stage avascular necrosis of the humeral head: current concepts and techniques

  • Michael D. Scheidt (Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center) ;
  • Saleh Aiyash (Department of General Surgery, Huntington Memorial Hospital) ;
  • Dane Salazar (Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center) ;
  • Nickolas Garbis (Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center)
  • Received : 2022.04.13
  • Accepted : 2022.07.07
  • Published : 2023.06.01
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Abstract

Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.

Keywords

References

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