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Liu Y, Zhong J, Jiang Z, Shen D, Zhao D. Surgical treatment of subchondral osteonecrosis of the humeral head: A case report and literature review. Medicine (Baltimore) 2023; 102:e34389. [PMID: 37543828 PMCID: PMC10403038 DOI: 10.1097/md.0000000000034389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Osteonecrosis of the humeral head is an uncommon subchondral bone disease with many etiologies, and there is currently no definite evidence to support an optimal surgical treatment plan. We report a case of surgical treatment of left humeral head necrosis. To the best of our knowledge, this is the youngest patient with non-drug-induced humeral head necrosis and the largest collapsed area. CASE PRESENTATION The case involved a 16-year-old male who injured his left shoulder 1 year ago. The patient was admitted to the hospital because of shoulder pain after activity in the year following the injury. During the physical examination, the left glenohumeral joint space was tender, the pain was obvious when the shoulder joint was rotated and squeezed, and the active and passive range of motion was normal. X-ray, magnetic resonance imaging, and computed tomography + 3D computed tomography scans all showed subchondral osteonecrosis of the left humeral head. Left humeral head lesion removal and autologous osteochondral transplantation were performed, and the patient was followed up. CONCLUSION Non-drug-induced humeral head necrosis is rare. Autologous osteochondral transplantation is currently one of the most mature and effective treatment methods. The short-term curative effect in this patient is satisfactory, but the patient is young and has a large collapsed area, so long-term follow-up is worthwhile.
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Affiliation(s)
- Yongsheng Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, China
| | - Jia Zhong
- Department of Orthopaedics, The People's Hospital of XiShuangBanBa State, China
| | - Zhaowei Jiang
- Department of Orthopaedics, The People's Hospital of Dehong State, China
| | - Duo Shen
- Department of Orthopaedics, The People's Hospital of Longchuan County, China
| | - Daohong Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, China
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Hotta T, Kozono N, Takeuchi N, Nabeshima A, Kawahara S, Hamai S, Akasaki Y, Tsushima H, Tashiro E, Konishi T, Nakashima Y. Steroid-induced osteonecrosis of the humeral head in a 20-year-old man treated with an osteochondral autograft: A case report. Mod Rheumatol Case Rep 2023; 7:247-251. [PMID: 35460258 DOI: 10.1093/mrcr/rxac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 01/07/2023]
Abstract
To our knowledge, only one previous report described the treatment of osteochondral autograft for steroid-induced osteonecrosis of the humeral head (ONHH) in a middle-aged patient. The present report describes a 20-year-old man who was found to have avascular osteonecrosis of the right humeral head after corticosteroid pulse treatment, followed by oral corticosteroid therapy. The patient complained of serious right shoulder pain and limited range of motion (ROM). Anteroposterior (AP) radiographs of the right shoulder revealed a crescent sign at the humeral head, indicating subchondral bone collapse with a linear sclerotic change and normal articular surface of the glenoid. The case was categorized as Stage 3 according to the Cruess classification. In general, Cruess classification Stage 3 is treated with humeral head replacement and shoulder arthroplasty. The patient underwent surgical treatment involving osteochondral autograft transplantation. Autografts were harvested from the right knee. At the 1.5-year follow-up, the patient was pain-free and showed an improved active ROM. Furthermore, AP radiographs demonstrated that the glenohumeral joint space was maintained, and no progression of humeral head collapse was observed. This case may be helpful in decision-making if young patients with ONHH require surgical treatment. Furthermore, osteochondral autograft transplantation may be an effective treatment for ONHH.
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Affiliation(s)
- Tadahiro Hotta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, Japan
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naohide Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Diagnosis and treatment of avascular necrosis of the humeral head: Current concepts. J ISAKOS 2022; 8:108-113. [PMID: 36435432 DOI: 10.1016/j.jisako.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
Avascular necrosis (AVN) of the humeral head is an uncommon clinical entity which can result in significant morbidity for patients. There is a paucity of literature concerning humeral head AVN, which may be due to the relatively rarity of the condition and poorly understood nature. Despite being first described decades ago, the underlying pathophysiology leading to humeral head AVN is still poorly defined. While the staging of humeral head AVN is well described, not much is known about prognosticating factors to predict the eventual course. Most of the management options are based on that of femoral head AVN, and even so, there is a paucity of good quality clinical trials in the literature. This current concepts paper describes what is known about humeral head AVN and proposes a management algorithm to guide clinicians.
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Na SS, Kim DH, Choi BC, Cho CH. Outcomes and complications after arthroplasty in patients with osteonecrosis of humeral head- systematic review. J Orthop Sci 2022:S0949-2658(22)00082-3. [PMID: 35490079 DOI: 10.1016/j.jos.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the outcomes and complications of hemiarthroplasty (HA) and total shoulder arthroplasty (TSA) in patients of osteonecrosis of humeral head (ONHH) through systematic review. METHODS PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, Scopus, Ovid, and Cochrane Library databases. Keywords included ONHH, avascular necrosis, head replacement, hemiarthroplasty, or total shoulder arthroplasty. Methodological Index for Nonrandomized Studies (MINORS) was used for quality assessment. RESULTS Ten studies (416 shoulders) were finally eligible and mean MINORS score was 11.9 (ranges, 8-16). HA was performed in 255 shoulders (61.3%) and TSA in 161 (38.7%). Mean age of the patients at the time of surgery was 50.6 years and mean follow-up period was 73.1 months. All clinical scores with range of motion were significantly improved after surgery. Overall complication rate was 20.0% with 10.1% in HA and 17.5% in TSA (p = 0.077). Overall reoperation rate was 11.2% with 7.0% in HA and 15.0% in TSA (p = 0.046). Overall revision rate was 6.4% with 5.7% in HA and 9.2% in TSA (p = 0.349). CONCLUSIONS Both HA and TSA in patients with ONHH yielded functional improvement with pain relief, but TSA had higher reoperation rate compared to HA.
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Affiliation(s)
- Sang-Soo Na
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
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