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Desai VM, Syed AN, Batley M, Wells L, Williams BA. Management of osteonecrosis of the humeral head in the pediatric population: A systematic review. J Child Orthop 2024; 18:432-440. [PMID: 39100979 PMCID: PMC11295367 DOI: 10.1177/18632521241254708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/25/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Humeral head osteonecrosis in the pediatric patients most often occurs in patients with underlying hemoglobinopathies, exposure to chronic corticosteroids, or after trauma. The purpose of this study was to perform a systematic review evaluating the prevalence, clinical characteristics, and management of humeral head osteonecrosis in the pediatric population. Methods PubMed, Ovid MEDLINE, and Scopus were screened with the terms "osteonecrosis," "avascular necrosis," "pediatric," and "proximal humerus" on January 10, 2024. A total of 218 studies were screened, and 74 studies were evaluated for eligibility. Studies that reported on the prevalence and/or management of pediatric humeral head osteonecrosis were included. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Results Twelve studies met inclusion criteria: four retrospective case series, three prospective case series, one retrospective cohort study, one retrospective case-control study, and three case reports. A majority of the studies (67%) discussed chemotherapy-induced osteonecrosis of the humeral head. A total of 77 patients (106 shoulders) with humeral head osteonecrosis were identified. The overall prevalence of osteonecrosis of the humeral head across eight studies examining at-risk populations (underlying hemoglobinopathies or undergoing chemotherapy) was 2%. Intra-articular steroid injections, physical therapy, and activity modification are effective conservative management strategies. Additionally, core decompression and hemiarthroplasty are surgical treatment options. Conclusions The prevalence of osteonecrosis of the humeral head is low even among at-risk populations with associated medical conditions. A variety of conservative and surgical treatment options have been described, but no comparative evaluations of these modalities has been conducted. Level of evidence IV.
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Affiliation(s)
- Vineet M Desai
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Harvard Medical School, Boston, MA, USA
| | - Akbar N Syed
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Batley
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Wells
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Ou Z, Feng Q, Peng L, Zhou M, Rai S, Tang X. Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:31-40. [PMID: 37566131 DOI: 10.1007/s00402-023-05020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH. METHODS Literature was retrieved from PubMed, Cochrane Library, Embase, Web of Science, and Scopus for eligible studies published up to January 2023. The pooled odds ratios (ORs) were calculated with their corresponding 95% confidence intervals (CIs) to evaluate. STATA 15.1 software was applied for data synthesis, sensitivity synthesis, and publication bias. RESULTS 45 articles were published between 2000 and 2022, and 2482 patients were finally included. All articles were observational research, with 7 case-control studies and 38 cohort studies, and the Newcastle Ottawa Scale (NOS) score ranged from 7 to 9. The pooled results suggested that age (OR 0.32, 95% CI 0.14-0.74, P = 0.01), reduction quality (OR 0.08, 95% CI 0.01-0.44, P = 0.00), fracture type (OR 0.44, 95% CI 0.25-0.78, P = 0.01), surgical approach (OR: 4.06, 95% CI 1.21-13.61, P = 0.02) and fixation implant (OR = 0.68, 95% CI = 0.34-1.33, P = 0.02) were risk factors for ONHH after IFPHF. According to sensitivity analysis, Begg (P = 0.42) and Egger (P = 0.68) tests, the results were stable and exhibited no publication bias. CONCLUSIONS The study showed that age, reduction quality, fracture type, surgical approach and fixation implant were risk factors for ONHH after IFPHF, while gender, varus or valgus, timely operation, injured side, and the existence of medial support have little influence on ONHH, as they could not be considered risk factors and still need further investigations.
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Affiliation(s)
- ZiXuan Ou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - QiYuan Feng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - LianQi Peng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - MinQi Zhou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Orthopaedics, Al Ahalia Hospital, Abu Dhabi, United Arab Emirates
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Jeong HJ, Park JW, Lee YK, Koo KH, Oh JH. Comparison between osteonecrosis of the humeral and femoral heads - epidemiological analysis of the surgical trend using the nationwide claims database of the republic of Korea. BMC Musculoskelet Disord 2023; 24:878. [PMID: 37951880 PMCID: PMC10638789 DOI: 10.1186/s12891-023-07022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUNDS The humeral head is the second most common site of osteonecrosis, after the femoral head. However, compared to osteonecrosis of the femoral head (ONFH), epidemiological information on osteonecrosis of the humeral head (ONHH) is scarce. We hypothesised that different biomechanical properties of the shoulder from the hip joint might present different epidemiological characteristics of ONHH from those of the ONFH. To evaluate epidemiological differences, we compared trends in the surgical treatment of ONHH and ONFH using the nationwide medical claims database of the Republic of Korea (ROK). METHODS We analysed epidemiological data from the Health Insurance Review and Assessment (HIRA) database of the ROK between 2008 and 2018. HIRA database contains almost all medical information in an anonymised form, including demographics, diagnoses, and types of surgical procedures, generated through healthcare practices in ROK. The annual incidence rates of ONHH and ONFH were calculated based on the total number of the general population. Demographics, annual incidence, and the proportion of post-traumatic osteonecrosis and surgical procedures were compared according to the anatomical site and the affected year. RESULTS The total number of patients treated for ONHH and ONFH during the study period was 1,028 and 66,260, respectively. Although the incidence of ONHH increased, it is a relatively rare disease compared to ONFH. ONHH occurred more frequently in females, while ONFH occurred predominantly in male patients (p < 0.001). Surgical treatment for ONHH was most frequently performed in older patients (63.7%), whereas middle-aged patients had the largest proportion of ONFH (48.9%, p < 0.001). The proportion of post-traumatic osteonecrosis was significantly higher in the ONHH (5.1%) than in the ONFH (1.9%, p < 0.001). Arthroplasty was performed more frequently in the ONHH (96.0%) than in the ONFH (92.9%, p < 0.001). CONCLUSION Despite the anatomical similarities between the hip and shoulder joints, the different biomechanical properties, such as weight-bearing functions, might cause epidemiological differences between ONHH and ONFH.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.
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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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5
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Cehelyk EK, Stull JD, Patel MS, Cox RM, Namdari S. Humeral Head Avascular Necrosis: Pathophysiology, Work-up, and Treatment Options. JBJS Rev 2023; 11:01874474-202306000-00017. [PMID: 37368960 DOI: 10.2106/jbjs.rvw.23.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
» Avascular necrosis (AVN) of the humeral head is the result of ischemic injury to the epiphyseal bone leading to humeral head collapse and arthritis.» Common causes include trauma, chronic corticosteroid use, or systemic disease processes, such as sickle cell disease, systemic lupus erythematosus, or alcohol abuse.» Nonoperative treatment consists of risk factor management, physical therapy, anti-inflammatory medications, and activity modification.» Surgical treatment options include arthroscopic debridement, core decompression, vascularized bone grafts, and shoulder arthroplasty.
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Affiliation(s)
- Eli K Cehelyk
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Justin D Stull
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Manan S Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan M Cox
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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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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7
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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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8
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Wang KC, Kantrowitz DE, Patel AV, Parsons BO, Flatow EL, Cagle PJ. Survivorship of total shoulder arthroplasty vs. hemiarthroplasty for the treatment of avascular necrosis at greater than 10-year follow-up. J Shoulder Elbow Surg 2022; 31:1782-1788. [PMID: 35339708 DOI: 10.1016/j.jse.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the humeral head is a debilitating pathology that can be managed with an array of treatments depending on disease staging. Humeral head arthroplasty for AVN has demonstrated good short-term improvements in pain and range of motion, but the published long-term outcomes data are limited. The objective of this study was to report long-term survivorship and outcomes for patients undergoing hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) for the treatment of AVN of the humeral head. METHODS The practice of one fellowship-trained shoulder surgeon was queried for the surgical treatment of AVN of the humeral head via appropriate International Classification of Diseases, Ninth and Tenth Revision, codes. Sixteen shoulders that met inclusion criteria were identified. Demographics included the radiographic stage, age, sex, American Society of Anesthesiologists (ASA) score, and body mass index. The primary endpoint was survivorship of the implant. Secondary endpoints were range of motion in forward elevation, internal and external rotation, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Simple Shoulder Test score. RESULTS Of the 16 shoulders included in the study, 10 underwent HA and 6 underwent TSA. The TSA cohort was significantly older (mean 60.5 vs. 44.2, P = .005), with a higher mean ASA score (mean 3.0 vs. 2.13, P = .02) than the HA group. The 10-year survivorship rates were 88.9% for HA and 80% for TSA with no significant difference between groups. Survivorship data were available for a mean 13.0 ± 5.6 years' follow-up in the HA group and 13.8 ± 4.8 years in the TSA group. When compared to one another, the results between HA and TSA only differed in internal rotation, which was statistically significantly improved in the TSA group compared with HA (2.3 ± 2.6 compared with -3.0 ± 5.0, P = .03). CONCLUSION The survivorship of both TSA and HA for the treatment of AVN was at least 80% at 10 years. Secondary endpoints, such as range of motion, pain, and shoulder function, improved significantly postoperatively in each cohort and were similar between the 2 groups, except for internal rotation, which had improved significantly more in the TSA group than in HA. Both TSA and HA are viable options for the treatment of AVN, each with durable long-term survival.
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Affiliation(s)
- Kevin C Wang
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - David E Kantrowitz
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA.
| | - Akshar V Patel
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
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9
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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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10
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Keough N, Lorke DE. The humeral head: A review of the blood supply and possible link to osteonecrosis following rotator cuff repair. J Anat 2021; 239:973-982. [PMID: 34164802 PMCID: PMC8546514 DOI: 10.1111/joa.13496] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
Trauma, corticosteroid therapy and metabolic diseases are well established aetiologies of humeral head osteonecrosis; however, there is increasing evidence that arthroscopic rotator cuff surgery may be another possible cause. One of the reasons is that there may be inadvertent damage to the arterial blood supply to the humeral head during surgical intervention. The blood supply to the humeral head displays large amounts of variation with regard to origin, course and distribution. Therefore, to shed light on the pathogenesis, the blood supply of the humeral head is reviewed together with a summary of all reported cases of osteonecrosis of the humeral head that occurred following rotator cuff repair. Inconsistencies with regard to terminologies used and contradictions concerning arterial contributions from the anterior circumflex humeral artery and the posterior circumflex humeral artery towards humeral head supply are addressed. Moreover, variations in the course of the anterior circumflex humeral artery and its branches are summarized. The vascular anatomy of the humeral head is clinically relevant due to the close relationship of these blood vessels with the surgical repair sites for rotator cuff surgery and biceps tenotomies or tenodesis procedures. Potential sites of disruption of blood supply following arthroscopic rotator cuff surgery are discussed. Detailed knowledge of the course of the arteries supplying the humeral head may help to minimize the risk of vascular injury and subsequent osteonecrosis. Given the great interindividual variations of vascular anatomy, imaging procedures preceding arthroscopic rotator cuff surgery may be advisable.
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Affiliation(s)
- Natalie Keough
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Dietrich E Lorke
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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11
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Pyrocarbon Humeral Head in a Shoulder Hemiarthroplasty: Preliminary Results at 3 Years Follow-Up and Review of the Current Literature. Case Rep Orthop 2021; 2021:6633690. [PMID: 33954000 PMCID: PMC8060089 DOI: 10.1155/2021/6633690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
Shoulder hemiarthroplasty is a viable option in young patients with an intact rotator cuff in order to preserve the native glenoid. To avoid the dreaded and expected wear of the glenoid in very active shoulders, implants with humeral head coated with a high resistant and elastic material—pyrolytic carbon—are now an option. The authors present the first pyrocarbon coated hemishoulder arthroplasty performed at our Orthopedic Department in a patient with osteonecrosis of the humeral head. At three years of follow-up, the patient is pain free and without limitations in his daily work. The Constant score was applied pre- and postoperatively, and an improvement of 32 points was reported. Larger cohorts with long-term follow-up are required to confirm our promising results.
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12
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Rossi LA, Piuzzi NS, Shapiro SA. Glenohumeral Osteoarthritis: The Role for Orthobiologic Therapies: Platelet-Rich Plasma and Cell Therapies. JBJS Rev 2021; 8:e0075. [PMID: 32015271 PMCID: PMC7055935 DOI: 10.2106/jbjs.rvw.19.00075] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The glenohumeral (GH) joint ranks third on the list of the large joints that are most commonly affected by osteoarthritis, after the knee and the hip.
General nonsurgical modalities, including changes in daily activities, physical therapy, pharmacotherapy, and corticosteroid injections, constitute the mainstay of treatment. Most of these options, however, have shown moderate and short-term effectiveness. Arthroplasty techniques have proven to be successful for elderly patients. Nevertheless, replacement options are not optimal for younger patients because their functional demands are higher and prostheses have a finite life span. This has led to the search for new nonoperative treatment options to target this subgroup of patients. It has been suggested that orthobiologic therapies, including platelet-rich plasma (PRP) and cell therapies, present great promise and opportunity for the treatment of GH osteoarthritis. Despite the promising results that have been shown by cell therapies and PRP for treating degenerative joint conditions, additional studies are needed to provide more definitive conclusions.
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Affiliation(s)
| | - Nicolás S Piuzzi
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida.,Mayo Clinic Center for Regenerative Medicine, Rochester, Minnesota
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13
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O’Keefe K, King JJ, Farmer KW, Wright TW. Arthroscopically Assisted Surgical Decompression and Fibular Strut Grafting for Proximal Humerus Avascular Necrosis: Surgical Technique. Arthrosc Tech 2021; 10:e711-e719. [PMID: 33738206 PMCID: PMC7953167 DOI: 10.1016/j.eats.2020.10.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/25/2020] [Indexed: 02/03/2023] Open
Abstract
Avascular necrosis is a relatively common entity that affects the proximal humerus and can lead to substantial morbidity. It often occurs in younger patients for whom the traditional treatment of shoulder arthroplasty is not optimal. Fibular strut grafting to prevent humeral head collapse has been described as a viable treatment option. However, it is technically challenging to direct the fibular strut graft into the center of the bony infarct, where it will be most effective. This paper describes a technique of arthroscopically assisted fibular strut grafting for avascular necrosis of the humerus. This is a minimally invasive technique with low morbidity and an accurate way of placing the graft into the infarcted segment.
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Affiliation(s)
| | | | | | - Thomas W. Wright
- Address correspondence to Thomas W. Wright, M.D., Department of Orthopaedics and Rehabilitation, P. O. Box 112727, Gainesville, FL 32611-2727.
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14
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Guerin G, Habibi A, Hernigou P, Zilber S. Core decompression with autologous bone marrow aspirate injection in humeral head osteonecrosis in adults with sickle cell disease. INTERNATIONAL ORTHOPAEDICS 2021; 45:1257-1261. [PMID: 33547484 DOI: 10.1007/s00264-021-04962-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Sickle cell disease is often associated with osteonecrosis of the humeral head with a risk of progression to humeral head collapse. The aim of this study was to evaluate the clinical outcome and the effect on the necrosis evolution of humeral head core decompression with autologous bone marrow aspirate injection in these patients. METHODS Forty shoulders in 23 patients were treated with core decompression with autologous concentrated iliac crest bone marrow aspirate injection. Patients were followed for a minimum of two years (limits from 2 to 10 years). Functional outcomes metrics included the simple shoulder test (STT) and subjective shoulder value (SSV) as well as assessment of radiographic progression of disease. RESULTS Shoulder function improved significantly at final follow-up. The STT improved by 2.9 points (p = 0.001) and the SVV improved by 15 % (p = 0.001). However, based on radiologic features, the intervention did not halt the radiographic progression of disease nor did it result in healing of the lesion. The benefits were mainly clinical with diminished pain and functional improvement. CONCLUSION Improvement in shoulder function was observed following core decompression and bone marrow aspirate injection in patients with sickle cell disease and early humeral head necrosis stages. The procedure should not be considered for grade 3 or greater disease and for asymptomatic cases whatever the grade. Given the lack of radiographic improvement observed in this study, further study in the context of prospective controlled trials should be undertaken before this intervention can be widely recommended.
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Affiliation(s)
- Gilles Guerin
- Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, 51 avenue du Marechal de Lattre de Tassigny, 94010, Creteil, France
| | - Anoosha Habibi
- Sickle cell referral center, UPEC, Institut Mondor Recherche Biomédical (IMRB), Institut national de la Santé et de la Recherche médicale (INSERM) U955, APHP, Henri Mondor teaching hospital, DHU A-TVB, 94010, Creteil, France
| | - Philippe Hernigou
- Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, Creteil, France
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15
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Hasegawa A, Mihata T, Shimizu H, Kuno N, Neo M. Osteochondral autograft transplantation for the treatment of steroid-induced osteonecrosis of the humeral head: a case report. J Shoulder Elbow Surg 2021; 30:e76-e83. [PMID: 32920108 DOI: 10.1016/j.jse.2020.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroyuki Shimizu
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naoto Kuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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16
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Hernigou P, Hernigou J, Scarlat M. Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification. Orthop Surg 2020; 12:1340-1349. [PMID: 33015963 PMCID: PMC7670135 DOI: 10.1111/os.12788] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022] Open
Abstract
The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as traumatism, corticosteroid use, sickle cell disease, alcoholism, dysbarism (or caisson disease), and Gaucher's disease. The diagnosis is clinical and radiographic with MRI, with radiographs being the basis for staging. Many theories have been proposed to decipher the mechanism behind the development of osteonecrosis, but none have been proven. Because osteonecrosis may affect patients with a variety of risk factors, it is important that caregivers have a heightened index of suspicion. Early detection may affect prognosis because prognosis is dependent on the stage and location of the disease. In particular, the disease should be suspected in patients with a history of fractures, steroid usage, or sickle cell disease, and in divers. This report reviews osteonecrosis of the humeral head, with an emphasis on causes, clinical evaluation, imaging, and classification.
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17
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Ibounig T, Simons T, Launonen A, Paavola M. Glenohumeral Osteoarthritis: An Overview of Etiology and Diagnostics. Scand J Surg 2020; 110:441-451. [PMID: 32662351 DOI: 10.1177/1457496920935018] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Osteoarthritis (OA) is the world's most common joint disease and there is currently no cure. Glenohumeral osteoarthritis (GHOA) accounts for an estimated 5% -17% of patients with shoulder complaints. The etiology of GHOA is multifactorial, and we review the various non-specific and specific risk factors and further sub-classify them into local and systemic factors. MATERIALS AND METHODS Data for this review article were identified by searches of MEDLINE, PubMed, and references from relevant articles using search terms such as "glenohumeral," "osteoarthritis," "epidemiology," "etiology," "imaging," and "pathophysiology." Only articles published in English, German, and Finnish between 1957 and 2017 were included. RESULTS The prevalence of radiological shoulder OA has been estimated to be as high as 16% -20% in the middle-aged and elderly population, but the concordance between structural findings and symptoms seems to be weak, as many of these individuals are asymptomatic. The vast majority of GHOA is related to non-specific factors, namely advancing age, while specific risk factors are commonly found in young patients. Diagnosis of GHOA is made when typical clinical features and defined radiological findings overlap in an individual. CONCLUSION Ultimately the determinants of shoulder pain in GHOA remain incompletely understood. Improved understanding of the etiology and diagnosis of GHOA will enable clinicians to better determine which patients will benefit from different treatment modalities, as well as provide new avenues to potential treatments.
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Affiliation(s)
- T Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Center of Evidence based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland
| | - T Simons
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - M Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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18
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Hatta T, Statz JM, Itoi E, Cofield RH, Sperling JW, Morrey ME. Shoulder arthroplasty in patients with immunosuppression following solid organ transplantation. J Shoulder Elbow Surg 2020; 29:44-49. [PMID: 31401131 DOI: 10.1016/j.jse.2019.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose was to determine the risk and outcomes of primary shoulder arthroplasties in patients with immunosuppression who had undergone solid organ transplantation. METHODS Using a single institution's total joint registry, we reviewed 30 primary shoulder arthroplasties in 25 post-transplantation patients, including 12 total shoulder arthroplasties, 10 hemiarthroplasties, and 8 reverse shoulder arthroplasties, between 1985 and 2012. Therapy and patient variables were recorded, including immunosuppressive therapy protocols, the date of preceding solid organ transplantation, and specific medications taken in the perioperative period. We matched a cohort of control patients for age, sex, type of implant, and year of surgery at a ratio of 4:1. Two groups were compared regarding mortality risk, complications, and clinical outcomes (pain score, range of motion, and American Shoulder and Elbow Surgeons score). RESULTS No periprosthetic infections occurred in the post-transplantation group at a mean follow-up of 39 months. However, the post-transplantation group showed an increased risk of periprosthetic fractures compared with the control group (hazard ratio, 8.18; 95% confidence interval, 1.22-70.98; P = .03). Despite the increase in fractures, the overall number of complications did not differ between the groups. Furthermore, postoperative shoulder function and outcome scores were not significantly different between patients who had a prior transplant and those who did not. CONCLUSION Primary shoulder arthroplasty in patients with immunosuppression who underwent solid organ transplantation is a successful procedure to treat glenohumeral arthritis. In contrast, there may be an increased risk of periprosthetic fractures in patients with a history of a solid organ transplant.
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Affiliation(s)
- Taku Hatta
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eiji Itoi
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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19
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Zhang M, Chen D, Zhang F, Zhang G, Wang Y, Zhang Q, He W, Wang H, Chen P. Serum exosomal hsa-miR-135b-5p serves as a potential diagnostic biomarker in steroid-induced osteonecrosis of femoral head. Am J Transl Res 2020; 12:2136-2154. [PMID: 32509207 PMCID: PMC7269975 DOI: pmid/32509207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023]
Abstract
Accumulating studies have demonstrated serum exosomal microRNAs (miRNAs) represent novel biomarkers for various diseases. In this study, we aimed to explore the feasibility of using serum exosomal miRNAs as novel serological biomarkers for steroid-induced osteonecrosis of femoral head (SONFH). We identified the characters of exosomes which were obtained from fresh serum of 5 systemic lupus erythematosus (SLE) patients without SONFH, 5 SLE patients with SONFH (SLE-SONFH) and 5 healthy ones. Comprehensive exosomal miRNA sequencing was performed to profile the differentially expressed miRNAs in the three groups. We then validated the expression levels of selected miRNAs by qRT-PCR. Furthermore, KEGG pathway, GO annotation, protein-protein interaction (PPI) network, module analysis and miRNAs-mRNAs interaction network were built to analyze the potential targets and mechanism. Sequencing data conveyed that hsa-miR-135b-5p, hsa-miR-150-5p, hsa-miR-509-3-5p, hsa-miR-514a-3p and hsa-miR-708-5p were significantly differentially expressed in the three groups. The results of qRT-PCR for the first time confirmed that the expression of hsa-miR-135b-5p was strikingly up-regulated in SLE-SONFH group which were consistent with miRNA sequencing results. In addition, bioinformatics analysis indicated that the enriched functions and pathways of the most differentially expressed miRNAs including Wnt, MAPK as well as Hippo signaling pathway. The top five hub genes (FGF2, PTEN, HACE1, VAMP2, and CBL) were part of module of the PPI network, which consisted of 713 nodes and 2191 edges. In conclusion, this study provides a novel and fundamental serum exosomal miRNAs profile of SONFH and hsa-miR-135b-5p may be identified as a unique diagnostic biomarker for SONFH.
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Affiliation(s)
- Meng Zhang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Lingnan Medical Research Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Delong Chen
- Department of Orthopaedic Surgery, Clifford Hospital, Jinan UniversityGuangzhou 510006, China
| | - Fan Zhang
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical CollegeShantou 515041, China
| | - Gangyu Zhang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Lingnan Medical Research Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Yueqi Wang
- Guangzhou Orthopaedic HospitalGuangzhou 510045, China
| | - Qingwen Zhang
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Wei He
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Haibin Wang
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Peng Chen
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
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20
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Kuo FY, Chen KL, Yen CC. Idiopathic humeral head osteonecrosis mimicking rotator cuff disorders: Two challenging diagnostic case reports. Medicine (Baltimore) 2020; 99:e18766. [PMID: 32011465 PMCID: PMC7220336 DOI: 10.1097/md.0000000000018766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Shoulder pain is a common complaint among patients, and rotator cuff disorders are the most common diagnoses. Humeral head osteonecrosis is easily masked by other more common diagnoses and concomitant conditions. PATIENT CONCERNS This challenging diagnostic report consists of 2 cases. Case 1 was that of a 59-year-old man who presented with right shoulder pain that had lasted for >1 year. Case 2 was that of a 52-year-old man who complained of right shoulder pain lasting for 6 months. They both presented with chronic right shoulder pain without relevant trauma history, and the physical examination showed a tenderness point over the right greater tuberosity. DIAGNOSIS These 2 patients were diagnosed with osteonecrosis involving the right greater tuberosity region via magnetic resonance imaging. INTERVENTIONS In case 1, the patient underwent cord decompression and artificial bone grafting with C-arm guidance. In case 2, the patient refused surgical intervention and decided to continue receiving physical therapy for symptom control. OUTCOMES In case 1, the patient responded well to cord decompression and artificial bone grafting. After the surgery, the active range of motion was restored and the pain in the right shoulder diminished further. In case 2, conservative treatment helped alleviate the patient's shoulder pain but did not entirely eliminate it. LESSONS Physicians should always have a high index of suspicion for osteonecrosis, especially when treating chronic shoulder pain, regardless of whether there are typical symptoms/known risk factors or not.
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Affiliation(s)
- Fang-Yu Kuo
- Department of Physical Medicine and Rehabilitation
| | - Kuan-Lin Chen
- Department of Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, Yumin Medical Corporation Yumin Hospital, Nantou
| | - Chieh-Chi Yen
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
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21
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Kim MS, Kim JY, Kim JD, Ro KH, Rhee YG. Rapidly destructive arthropathy of shoulder joint. J Shoulder Elbow Surg 2019; 28:2334-2342. [PMID: 31300369 DOI: 10.1016/j.jse.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rapidly destructive arthropathy (RDA) of the shoulder is rare. Consequently, there are very few studies that have reported the characteristic findings of this disease. This study aimed to analyze the clinical, radiographic, and histologic features of patients with RDA of the shoulder. METHODS In total, 9 cases (8 patients) were enrolled in this study. All patients were elderly women, with a mean age of 72.7 years (range, 57-78 years). The mean duration of symptoms was 4.1 months (range, 1.2-5.9 months). Reverse total shoulder arthroplasty and total shoulder arthroplasty were performed in 5 cases with massive rotator cuff tears and 4 without them, respectively. RESULTS The mean duration of radiologically evident joint destruction after negative results on radiography was 3.1 months (range, 1.0-5.9 months). On plain radiography, humeral head flattening and collapse that appeared like cut grass were observed (100%). Relatively good preservation of the glenoid with a normal joint space was observed in 7 cases, whereas glenoid erosion was observed in 2 (22.2%). T1-weighted magnetic resonance imaging showed a subchondral fracture (100%) of low signal intensity with associated bone marrow edema. Histologically, chronic inflammation of the synovium and osteocytes in the lacunae, as well as callus formation, were observed along the subchondral fracture. CONCLUSION Flattening and collapse of the humeral head within an average of 4 months of symptom onset are characteristic of RDA of the shoulder. Bone marrow edema, joint effusion, and subchondral fracture on magnetic resonance imaging and fracture fragments and callus formation on histopathologic analysis were observed. Glenoid erosion was observed in 2 cases with arthrosis progression.
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Affiliation(s)
- Myung Seo Kim
- Department of Orthopaedic Surgery, College of Medicine, Ulsan University, Ulsan, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jong Dae Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyung Han Ro
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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22
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Keough N, de Beer T, Uys A, Hohmann E. An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair. JSES OPEN ACCESS 2019; 3:320-327. [PMID: 31891033 PMCID: PMC6928301 DOI: 10.1016/j.jses.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background The purpose of this study was to investigate the blood supply of the humeral head (HH) originating from the anterior (ACHA) and posterior circumflex humeral arteries (PCHA). Methods Formalin preserved specimens were used to measure ACHA length, ACHA length in the bicipital groove (BG), the length of the ascending branch of the ACHA, the penetration point of the ascending branch of the ACHA at the greater tuberosity (GT), and the penetration point of the ascending branch PCHA at the GT. Fresh specimens were used to identify the intraosseous vascular network by both the ACHA and PCHA by injecting a contrast medium using a high-resolution microfocus computed tomography. Specimens were then dissected to expose where the branches of the ACHA and PCHA penetrate the bone, and a small section of the medial head was removed to visualize dye penetration of the cancellous bone. Results Seven variations for the course of the ACHA were observed. In 36%, the ACHA runs posterior to the BG and posterior to the long head of biceps tendon, and splits into the anterolateral ascending and descending branch. The ascending branch enters the medial wall of the GT. Microfocus computed tomography demonstrated that the intraosseous branch of the ascending branch of the ACHA runs within the GT in a medial direction from its penetration point just along the lateral edge of the BG. Intraosseous accumulation of contrast within the GT supply occurs more toward the inferior aspect of the HH, and the anterior-superior and superior-medial aspect of the HH is not perfused. This region is a high-risk zone for avascular necrosis. Conclusion The results of this study suggest that 7 variations for the course of the ACHA exist. These variations and the interruption of the intraosseous arterial network in the GT with surgery and suture anchor placement result in a high-risk zone in the superomedial aspect of the humeral head overlapping with the area where early aseptic necrosis is identified.
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Affiliation(s)
- Natalie Keough
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Thys de Beer
- Life Groenkloof Hospital, Pretoria, South Africa
| | - Andre Uys
- Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Erik Hohmann
- Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates.,School of Medicine, University of Pretoria, Pretoria, South Africa
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23
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Navarro SM, Haeberle HS, Khlopas A, Newman JM, Karnuta JM, Mont MA, Ramkumar PN. Short-term outcomes after anatomic total shoulder arthroplasty in patients with osteoarthritis versus osteonecrosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:48. [PMID: 30906752 DOI: 10.21037/atm.2018.12.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The outcomes of anatomic total shoulder arthroplasty (TSA) for glenohumeral osteoarthritis (OA) have been extensively reported in the literature. However, there is a paucity of short-term outcomes data on perioperative and post-operative outcomes in patients receiving TSA for either glenoid or humeral head osteonecrosis (ON). We compared the short-term outcomes of TSA performed on patients who had glenohumeral OA and those who had ON. Specifically, we compared: (I) demographics; (II) length-of-stay (LOS); and (III) 30-day postoperative complication rates. Methods Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to select 7,066 patients with a diagnosis of glenohumeral OA or ON who underwent TSA between January 1st, 2008 and December 31st, 2015. Propensity score matching was performed based on age, sex, race, and body mass index (BMI) with a 3:1 ratio of OA to ON patients. As a result, 387 patients who had a primary diagnosis of OA were compared with 129 patients who had ON. Analyses addressed perioperative complications and hospital disposition factors-including LOS and 30-day post-operative complications-using bivariate and logistic regression models. Results Overall complication rates were low in both groups, at 6.1% and 5.4% for the ON and OA cohorts respectively. The ON cohort had more comorbidities, including higher Charlson/Devo and American Society of Anesthesiologists (ASA) scores (P<0.05). Hospital disposition factors were not statistically different between the 2 groups. While not statistically significant, the ON cohort had a longer average (21.1% longer, P>0.05), an increased risk for developing any complication [odds ratio (OR) =2.07; 95% confidence interval (CI), 0.94 to 4.57; P=0.07], and a 134% higher risk for developing a minor complication compared to the OA (OR =2.34; 95% CI, 1.01 to 5.42; P=0.047). Conclusions Although the patient populations who develop ON or shoulder OA have differences, there are not statistically or clinically meaningful differences in the short-term outcomes after anatomic TSA. Future studies are required to examine if differences exist in the long-term follow-up between the two groups.
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Affiliation(s)
- Sergio M Navarro
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Heather S Haeberle
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA
| | - Jaret M Karnuta
- Department of Orthopaedic Surgery, Case Western University School of Medicine, Cleveland, OH, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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24
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Abstract
The manifestation of glenohumeral arthritis in the young adult is a devastating occurrence that can be difficult to manage. This review details the many underlying etiologies including genetic causes, congenital abnormalities, glenohumeral instability, posttraumatic lesions, postcapsulorraphy arthropathy, osteonecrosis, intraarticular pain pump postoperative use, radiofrequency/thermal capsulorraphy treatments, septic arthritis/infection, and inflammatory arthropathies. Although each of these potential causes have been well-studied, their contributions to the development of glenohumeral arthritis in the young person has not been described extensively.
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Affiliation(s)
- Michael S Laidlaw
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA
| | - Harrison S Mahon
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA.
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25
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Shoulder Arthroplasty for Humeral Head Avascular Necrosis Is Associated With Increased Postoperative Complications. HSS J 2018; 14:2-8. [PMID: 29398987 PMCID: PMC5786582 DOI: 10.1007/s11420-017-9562-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA). QUESTIONS/PURPOSES The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN. METHODS Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls. RESULTS The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications. CONCLUSIONS TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.
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Miyazaki AN, Silva LA, Sella GDV, Checchia CS, Simionato MC, Checchia SL. Articular reconstruction of the humeral head with autogenous allograft in the treatment of the osteonecrosis. Rev Bras Ortop 2018; 53:113-117. [PMID: 29367916 PMCID: PMC5771782 DOI: 10.1016/j.rboe.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
The authors describe a surgical biological reconstruction of the humeral head with frozen autogenous allograft technique for the treatment of young patients with focal osteonecrosis of the humeral head. This represents a possible alternative, maybe even definitive for some patients, when compared to hemiarthroplasty or total shoulder arthroplasty. The technique consists of the fixation of a frozen autogenous allograft with previously-molded articular cartilage from the humeral head, after cleansing the osteonecrotic focus. Five patients under 50 years of age were treated, with three very satisfactory results, one patient was lost to follow-up, and one patient had an unsatisfactory result (converted to hemiarthroplasty). The study describes the technique in detail and the three cases with a longer follow-up time.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Luciana Andrade Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Marcos Cazer Simionato
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Sergio Luiz Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Reconstrução da superfície articular da cabeça umeral com enxerto homólogo no tratamento da osteonecrose. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kim JK, Jeong HJ, Shin SJ, Yoo JC, Rhie TY, Park KJ, Oh JH. Rapid Progressive Osteonecrosis of the Humeral Head After Arthroscopic Rotator Cuff Surgery. Arthroscopy 2018; 34:41-47. [PMID: 28969947 DOI: 10.1016/j.arthro.2017.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To verify the clinical features and the risk factors of rapid progressive osteonecrosis of the humeral head after arthroscopic rotator cuff surgery (ARCS). METHODS Data and medical records of 24 patients who had rapid progressive collapse of the humeral head after ARCS performed from October 2012 to March 2016 were retrospectively analyzed. Among them, 8 patients demonstrated no evidence of osteonecrosis of the humeral head preoperatively yet developed rapid progressive collapse of the humeral head within 12 months after ARCS. RESULTS All patients were women with a mean age of 64.0 years (range, 52-74 years), and all of them had surgery on their dominant side. Sudden pain developed at a mean 4 months (range, 0-6 months) after index surgery. The rapid progressive collapse of the humeral head occurred within 12 months after index surgery. No clear risk factor or evidence supporting an association between ARCS and humeral head osteonecrosis was found. CONCLUSIONS Although the cause of the rapid progressive humeral head osteonecrosis after ARCS still needs to be established, surgeons should be aware of the possible development of humeral head osteonecrosis after ARCS, especially in older women with dominant arm involvement. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Je Kyun Kim
- Department of Orthopaedic Surgery Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sang-Jin Shin
- Ewha Shoulder Disease Center, Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Kyoung-Jin Park
- Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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Weber SC. Editorial Commentary: "Just When I Thought I'd Seen Everything That Could Go Wrong?" (Often Overheard in the Surgeon's Lounge): Osteonecrosis of the Humeral Head After Arthroscopic Rotator Cuff Surgery. Arthroscopy 2018; 34:48-49. [PMID: 29304978 DOI: 10.1016/j.arthro.2017.08.276] [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] [Received: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023]
Abstract
Osteonecrosis occurs postoperatively after rotator cuff repair, but is there a cause-and-effect relation?
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Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:3270-3278. [PMID: 27198139 DOI: 10.1007/s00167-016-4169-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Osteonecrosis of the humeral head is a rare diagnosis. The aim of this systematic review was to identify published studies and analyse the best clinical evidence available related to the surgical management of osteonecrosis of the humeral head. METHODS A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. Published studies that reported the outcomes for adult patients treated surgically for osteonecrosis of the humeral head were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was followed. RESULTS Twelve studies were included: five prospective case series and seven retrospective case series. A total of 309 patients, comprising 382 shoulders, were included. Three main surgical procedures were evaluated: core decompression, hemi-arthroplasty and total shoulder arthroplasty. CONCLUSIONS Based on the current available data, core decompression is a safe and effective option for treating low-grade osteonecrosis of the humeral head, while hemi-arthroplasty and total shoulder arthroplasty should be considered for high-grade osteonecrosis. More studies and better-designed trials are needed in order to enrich the evidence and enable researchers to draw stronger conclusions. Since osteonecrosis is an uncommon, though challenging disease, a proper knowledge of its treatment is needed. LEVEL OF EVIDENCE IV.
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Rinkinen J, Molway D, Carty M, Dyer GSM, Pomahac B, Chandraker A, Talbot SG. Avascular necrosis of the humeral head following bilateral upper extremity vascular composite allotransplantation: a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:60-64. [PMID: 28804740 PMCID: PMC5532758 DOI: 10.1080/23320885.2017.1345635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
Vascularised composite allotransplantation (VCA) represents an exciting and emerging field in plastic and reconstructive surgery. Despite the generally good functional and psychosocial outcomes, multiple complications can be associated with the procedure. The authors describe a case of avascular necrosis of the humeral head following successful upper extremity VCA.
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Affiliation(s)
- Jacob Rinkinen
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - David Molway
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Matthew Carty
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Anil Chandraker
- Division of Transplant Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
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Carlsen AW. Frequency of decompression illness among recent and extinct mammals and "reptiles": a review. Naturwissenschaften 2017; 104:56. [PMID: 28656350 DOI: 10.1007/s00114-017-1477-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/22/2023]
Abstract
The frequency of decompression illness was high among the extinct marine "reptiles" and very low among the marine mammals. Signs of decompression illness are still found among turtles but whales and seals are unaffected. In humans, the risk of decompression illness is five times increased in individuals with Patent Foramen Ovale; this condition allows blood shunting from the venous circuit to the systemic circuit. This right-left shunt is characteristic of the "reptile" heart, and it is suggested that this could contribute to the high frequency of decompression illness in the extinct reptiles.
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Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases. Case Rep Orthop 2017; 2017:4898057. [PMID: 28713606 PMCID: PMC5496114 DOI: 10.1155/2017/4898057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/30/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022] Open
Abstract
Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS). The mean follow-up period was 49.4 (range, 24–73) months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC) was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery.
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Abstract
Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity. Corticosteroids are the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates. Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Epigenetics may alter the predisposition to develop osteonecrosis. MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.
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Kennon JC, Smith JP, Crosby LA. Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. J Shoulder Elbow Surg 2016; 25:1442-8. [PMID: 27085764 DOI: 10.1016/j.jse.2016.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/07/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Justin C Kennon
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Jeffrey P Smith
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Lynn A Crosby
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA.
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Ozkunt O, Sarıyılmaz K, Sungur M, Ilen F, Dikici F. Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report. Int J Surg Case Rep 2015; 17:100-2. [PMID: 26595896 PMCID: PMC4701818 DOI: 10.1016/j.ijscr.2015.10.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/07/2015] [Accepted: 10/31/2015] [Indexed: 11/30/2022] Open
Abstract
We reported a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral total hip arthroplasty. We believe that there is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. We suggest reveal etiology for the more cost effective and more functional therapies.
Introduction Femoral head avascular necrosis is caused by disruption of the blood supply of the femoral head, which finally results in hip dysfunction. Non traumatic osteonecrosis may related with corticosteroid use, alcohol abuse, SLE, hemoglobinopathies or exposure to cytotoxic agents. But avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. We report a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral hip arthroplasty. Presentation of case 37 year-old male patient presented with bilateral hip pain that had been occurring for four years. The patient had no history of smoking, excessive drinking, using corticosteroid and the other drugs or trauma but used heroin for 10 years. In clinic and radiologic examination indicated advanced degenerative changes on both hip due to femoral head avascular necrosis. The patient was treated with simultaneous bilateral total hip arthroplasty. After 6 months postoperatively the active hip range of motion was painless. Discussion Avascular femoral head necrosis caused by the using of heroin is rare. Ultimately, osteonecrosis of the femoral head occurs through one final common pathway, which is decreased blood flow to the femoral head that leads bone ischemia and death. But it is still unknown that heroin’s systemic effects. Intravenous drug use more as a serious problem for today. There is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. Conclusion Heroin use will be important problem for population. That’s why is crucial to understand the effect of heroin.
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Affiliation(s)
- Okan Ozkunt
- Department of Orthopedics and Traumatology, Acibadem Atakent Univesity Hospital, Istanbul, Turkey.
| | - Kerim Sarıyılmaz
- Department of Orthopedics and Traumatology, Acibadem Atakent Univesity Hospital, Istanbul, Turkey
| | - Mustafa Sungur
- Department of Orthopedics and Traumatology, Acibadem Atakent Univesity Hospital, Istanbul, Turkey
| | - Ferhat Ilen
- Department of Orthopedics and Traumatology, Acibadem Atakent Univesity Hospital, Istanbul, Turkey
| | - Fatih Dikici
- Department of Orthopedics and Traumatology, Acibadem Atakent Univesity Hospital, Istanbul, Turkey
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Patel S, Colaco HB, Elvey ME, Lee MH. Post-traumatic osteonecrosis of the proximal humerus. Injury 2015; 46:1878-84. [PMID: 26113032 DOI: 10.1016/j.injury.2015.06.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
Abstract
Post-traumatic osteonecrosis of the proximal humerus represents a challenging problem to the surgeon. It is commonly seen following multi-fragmentary fractures of the proximal humerus which may affect the long-term functional recovery after such injuries. This review summarises the current evidence on risk factors, reasons why estimating its epidemiology is difficult, the vascular supply of the humeral head, classification, and management options.
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Affiliation(s)
- Shelain Patel
- Dept of Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom.
| | - Henry B Colaco
- Shoulder Unit, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Michael E Elvey
- Dept of Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Marcus H Lee
- Dept of Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
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Wu B, Dong Z, Li S, Song H. Steroid-induced ischemic bone necrosis of femoral head: Treatment strategies. Pak J Med Sci 2015; 31:471-6. [PMID: 26101514 PMCID: PMC4476365 DOI: 10.12669/pjms.312.6592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Fat hypertrophy, intravascular coagulation, and fat emboli are important risk factors of steroid-induced ischemic bone necrosis (SI-IBN) which may develop during the initial one year after commencing the use of steroids. This pathology is best studied by MRI, particularly for its staging. The cautious strategies such as low dose, oral route, short duration of steroid usage, use of steroid sparing agent, and alcohol avoidance should be followed as a traditional therapy. The objective of this review article was to recognize and evaluate various Treatment strategies for steroid-induced ischemic bone necrosis of femoral head. LITERATURE SEARCH Various electronic databases including PubMed, Google and Cochrane library were comprehensively searched for articles on steroid-induced ischemic bone necrosis of femoral head and its treatment strategies. Ninety four articles were reviewed, examined and importantly appraised and the most appropriate 32 papers were used to write this review article. CONCLUSION Bisphosphonates, alendronate, and hyperbaric oxygen (HBO) treatments have been reported to be effective against IBN. To recommend the regular use of bisphosphonate in IBN patients, more evidences with a larger number of patients are required to verify its therapeutic effectiveness. Core decompression, osteotomy, bone graft and tantalum rod are the surgical approaches for the management of IBN. Advance form of IBN (bone tissue collapse) is advised to be treated with arthroplasty which should be durable, particularly in young patients.
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Affiliation(s)
- Bin Wu
- Bin Wu, FCPS. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Zhong Dong
- Zhong Dong, MD. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Shuyuan Li
- Shuyuan Li, PhD. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Hongmei Song
- Hongmei Song, FCPS. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
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Kircher J, Patzer T, Ziskoven C, Bittersohl B, Hedtmann A, Krauspe R. Arthroscopically assisted retrograde drilling of the humeral head with a guiding device. Knee Surg Sports Traumatol Arthrosc 2015; 23:1442-1446. [PMID: 24296988 DOI: 10.1007/s00167-013-2783-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/16/2013] [Indexed: 10/26/2022]
Abstract
This manuscript describes the successful treatment of a steroid-induced avascular necrosis of the humeral head using arthroscopically assisted retrograde drilling of a stage II lesion using a guiding device. At the final follow-up 19 month post-operatively, the patient presented pain-free without functional limitations although the osteonecrosis had not been fully healed.
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Affiliation(s)
- Jörn Kircher
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40255, Düsseldorf, Germany.
- Department of Shoulder and Elbow Surgery, Klinik Fleetinsel Hamburg, Admiralitästrasse 2-4, 20459, Hamburg, Germany.
| | - Thilo Patzer
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40255, Düsseldorf, Germany
| | - Christoph Ziskoven
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40255, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40255, Düsseldorf, Germany
| | - Achim Hedtmann
- Department of Shoulder and Elbow Surgery, Klinik Fleetinsel Hamburg, Admiralitästrasse 2-4, 20459, Hamburg, Germany
| | - Rüdiger Krauspe
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40255, Düsseldorf, Germany
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Johnson MH, Paxton ES, Green A. Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts. J Shoulder Elbow Surg 2015; 24:317-25. [PMID: 25487897 DOI: 10.1016/j.jse.2014.09.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 09/07/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prosthetic shoulder arthroplasty provides excellent pain relief and functional restoration for patients with glenohumeral arthritis, but concerns of survivorship have limited its use in younger patients. DISCUSSION Despite general reports of high long-term survivorship, implant failure and functional deterioration after total shoulder arthroplasty are major concerns in the management of younger patients. In addition to having a longer life expectancy, younger patients also tend to be more active and can be expected to place greater demands on their shoulder arthroplasty. CONCLUSION Alternative strategies have been developed and used for shoulder arthroplasty in younger patients. This manuscript reviews current concepts of shoulder arthroplasty in young patients.
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Affiliation(s)
- Michael H Johnson
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - E Scott Paxton
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Summary of the various treatments for osteonecrosis of the femoral head by mechanism: A review. Exp Ther Med 2014; 8:700-706. [PMID: 25120585 PMCID: PMC4113634 DOI: 10.3892/etm.2014.1811] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/04/2014] [Indexed: 12/20/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH), also known as femoral head avascular necrosis, is a pathological state with a number of possible etiologies including steroid administration, alcohol abuse, traumatic events, vascular injury and idiopathic origins. ONFH causes a reduction in the vascular supply to the subchondral bone of the femoral head, which results in osteocyte death and the collapse of the articular surface. Treatments for ONFH include non-weight-bearing therapy, physical support, the promotion of osteoclast apoptosis, and the reduction of osteoblast and osteocyte apoptosis. The aim of the present review was to summarize the treatments for ONFH by mechanism from a new perspective and to describe the condition with an emphasis on treatment options.
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Byun JW, Shim JH, Shin WJ, Cho SY. Rapid progressive atypical atraumatic osteonecrosis of humeral head: a case report. Korean J Anesthesiol 2014; 66:398-401. [PMID: 24910734 PMCID: PMC4041961 DOI: 10.4097/kjae.2014.66.5.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/20/2013] [Indexed: 11/29/2022] Open
Abstract
Osteonecrosis of the humeral head is an uncommon and slow progressive condition. This condition is difficult to be recognized because its initial symptoms are nonspecific. Simple radiography is the standard tool to stage disease progression. However, plain radiographic findings of osteonecrosis are nearly normal in the initial stage. We report a case of 74 years old female patient who have suffered from painful limitation of the shoulder joint. She had no trauma history and no specific predisposing factors for osteonecrosis of the humeral head. To confirm, follow up radiography and shoulder magnetic resonance imaging were performed.
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Affiliation(s)
- Jang Won Byun
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Jae-Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Woo Jong Shin
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sang Yoon Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
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Yoo IS, Park CK, Kim Y, Song ST, Choi SW, Kim JH, Kang SW. Osteonecrosis of the Humeral Head after Cerebral Angiography. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- In Seol Yoo
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan-Keol Park
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung Taek Song
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hyun Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seong Wook Kang
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Wu D, Song D, Ni J, Dai R. Avascular necrosis of the femoral head due to the bilateral injection of heroin into the femoral vein: A case report. Exp Ther Med 2013; 6:1041-1043. [PMID: 24137312 PMCID: PMC3797317 DOI: 10.3892/etm.2013.1236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/18/2013] [Indexed: 12/26/2022] Open
Abstract
In this study, we report a case of avascular necrosis of the femoral head (ANFH) caused by the bilateral intravenous injection of heroin into the femoral vein. The patient had not used steroids, did not smoke and did not drink excessively. The patient did not present with any systemic diseases that may cause ANFH. ANFH often causes changes to the bone mass of the femoral head, particularly, the weight-bearing bone region. Imaging examination revealed that in addition to the bilateral hip joints, widespread changes to the bone mass existed in the peripheral area, where phlebitis and disseminated thrombosis had been caused by the injection of heroin. These results suggest that this ANFH case was related to the injection of heroin. This case is different from other cases of ANFH which have been caused by steroids and other factors, including smoking, alcohol intake and cytotoxic agents.
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Affiliation(s)
- Dengke Wu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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45
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Dexel J, Kasten P. Bilateral idiopathic osteonecrosis of the major tubercle of the humerus. Knee Surg Sports Traumatol Arthrosc 2013; 21:1168-70. [PMID: 22547250 DOI: 10.1007/s00167-012-2025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/16/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Bilateral osteonecrosis of the tuberculum majus has not been reported in the literature. A case of bilateral avascular necrosis of the tuberculum majus is presented associated with smoking and occasional alcohol consumption as risk factors, which was successfully treated with non-operative treatment. LEVEL OF EVIDENCE Case report, Level V.
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Affiliation(s)
- Julian Dexel
- Department of Orthopaedic Surgery, Carl Gustav Carus University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Dilisio MF, Noble JS, Bell RH, Noel CR. Postarthroscopic humeral head osteonecrosis treated with reverse total shoulder arthroplasty. Orthopedics 2013; 36:e377-80. [PMID: 23464961 DOI: 10.3928/01477447-20130222-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although postarthroscopic glenohumeral chondrolysis has become a well-known disastrous complication of arthroscopic shoulder surgery, little is known about postarthroscopic humeral head osteonecrosis. This article describes 3 patients who were referred to the authors' practice with end-stage osteonecrosis after an arthroscopic rotator cuff repair or debridement.Three patients (average age, 63.3 years) presented to the authors' practice reporting severe shoulder pain after a rotator cuff debridement or repair was performed at an outside facility. After an interval period of mild improvement, all patients experienced progressive pain and loss of shoulder range of motion at a mean of 4.8 months postoperatively. Plain radiographs and magnetic resonance imaging obtained prior to the index operation showed no evidence of osteonecrosis. Postoperatively, progressive clinical and radiographic evidence showed humeral head osteonecrosis and subsequent glenohumeral destruction with cuff tear arthropathy. The authors managed all patients with a reverse total shoulder arthroplasty due to severe glenohumeral arthrosis and massive rotator cuff tears not amendable to repair. Satisfactory results were achieved in all cases.Although many complications of arthroscopic shoulder surgery are documented, little is known about postarthroscopic humeral head osteonecrosis. Shoulder surgeons should be aware of this potential complication when performing arthroscopic rotator cuff surgery and when evaluating painful and stiff postarthroscopic shoulders.
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Affiliation(s)
- Matthew F Dilisio
- Department of Orthopaedic Surgery, Summa Health System, Akron, OH 44310, USA.
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Razmjou H, Holtby R, Christakis M, Axelrod T, Richards R. Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study. J Shoulder Elbow Surg 2013; 22:206-14. [PMID: 22819578 DOI: 10.1016/j.jse.2012.04.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/10/2012] [Accepted: 04/22/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND This prospective longitudinal study compared clinical and radiologic outcomes of total shoulder arthroplasty (TSA) using 3 different prosthetic designs, the Neer II system, the Bigliani-Flatow (BF), and a stemless prosthesis, the Total Evolutive Shoulder System (TESS). MATERIALS AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA were followed up for 2 years. Four patient-oriented disability outcomes were used. The clinical data collected before surgery and at follow-up assessments during a 2-year period included active range of motion (ROM) in 6 directions and strength. Radiographic signs of glenoid and humeral component loosening were recorded. The incidence of humeral head subluxation was documented. RESULTS Seventy-four patients completed the study. There was a significant improvement in the 4 disability measures, ROM, and strength at 2 years in all 3 groups (P < .0001). Active external rotation at 90° abduction was statistically significantly lower in the Neer II group (P = .001). The incidence of lucent lines around the glenoid component was higher in the Neer II group (P = .0002). No statistically significant relationship was seen between type of prosthesis and patient satisfaction (P > 0.05). CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction. The Neer II was associated with less active external rotation and more lucent lines.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Abstract
Osteonecrosis affects younger patients more often than osteoarthritis and has significantly greater long-term morbidity. Corticosteroids constitute the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. Bisphosphonate use is associated with osteonecrosis of the jaw. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Magnetic resonance imaging is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although there are many variations on surgical treatment of femoral head osteonecrosis, most patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Due to the lack of successful treatment options, new modes focus on prevention of osteonecrosis.
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Deep-diving dinosaurs. Naturwissenschaften 2012; 99:671-2; author reply 673-4. [PMID: 22824942 DOI: 10.1007/s00114-012-0937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
Dysbaric bone necrosis demonstrated in ichthyosaurs may be the result of prolonged deep diving rather than rapid ascent to escape predators. The bone lesions show structural and anatomical similarity to those that may occur in human divers and in the deep diving sperm whale, Physeter macrocephalus.
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Kuether G, Dietrich B, Smith T, Peter C, Gruessner S. Atraumatic osteonecrosis of the humeral head after influenza A-(H1N1) v-2009 vaccination. Vaccine 2011; 29:6830-3. [PMID: 21803092 DOI: 10.1016/j.vaccine.2011.07.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/30/2011] [Accepted: 07/16/2011] [Indexed: 11/18/2022]
Abstract
In the recent pandemic influenza A-(H1N1) v-2009 vaccination campaign, adjuvanted vaccines have been used because of their antigen-sparing effect. According to available reports, the rate of severe vaccination reactions has not increased, as compared with previous seasonal influenza vaccinations. Here we describe an adult female patient who was vaccinated with an AS03 adjuvanted split-virus vaccine injected into the left arm. She experienced a prolonged and painful local reaction for 4 weeks. During this time, persistent incapacitating pain shifted into the left shoulder. Magnetic resonance imaging (MRI) at the injection site detected atraumatic humeral head osteonecrosis in conjunction with bursitis of the rotator cuff region. Clinical and laboratory examination revealed no other underlying disease. Using analgetic medication and physical therapy, resting pain completely remitted within the following 14 weeks. Pain on exertion declined within the following 6 months. Atraumatic osteonecrosis, a relatively rare disorder which initially presents non-specific clinical symptoms, has never been associated with parenteral influenza vaccination. Although the available data cannot establish a causal relationship, our patient's clinical course - with a continuous transition from increased local post-vaccination reactions to symptoms of a severe shoulder lesion with osteonecrosis - raises the question of a pathogenetic link. Considering the vascular pathogenesis of osteonecrosis, we hypothesize that our patient's enhanced local immunologic reaction may have led to regional vasculitis as the cause of bone destruction. As mild forms of osteonecrosis may have escaped previous clinical attention, it is the purpose of our report to increase awareness of this exceptional event as a possible side effect of parenteral adjuvanted vaccination.
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Affiliation(s)
- G Kuether
- Department of Rehabilitation Medicine, Hannover Medical School, Germany.
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