“…1 ): three retrospective cohort studies (2 level III and 1 level IV evidence) 4 , 7 , 25 and three case series (level IV evidence). 10 , 13 , 14 In those six studies, forty-three (SCD) patients, comprising forty-nine shoulders, underwent different surgical interventions for HHAVN ( Table II ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…of shoulders (patients) Mean age (range) No. of shoulders (patients) % of SCD shoulders Ristow et al 25 2019 III Retrospective cohort TSA vs. HA 29 (25) 49 (16-77) 8 (6) 27.6 22 Colegate-Stone et al 4 2018 IV Retrospective cohort Arthroscopic intervention∗, HA, and RTSA 45 (45) 40 (21-62) 11 (11) 24.4 II, III, IV 11 Kennon et al 13 2016 IV Case series Decompression, resurfacing, HA, TSA, and RTSA 25 (20) 37 ± 15 13 (11) 52 I, II, III, IV 14 Harreld et al 10 2009 IV Case series Decompression 26 (15) 37 (15-50) 5 (3) 19.2 I, II 20 Feeley et al 7 2008 III Retrospective cohort TSA vs. HA 64 (64) 57 (46-77) 4 (4) 6.2 22 Lau et al. 14 2007 IV Case series TSA, HA 8 (8) 37 (25-47) 8 (8) 100 II, III, IV, V …”
Section: Resultsmentioning
confidence: 99%
“… Author Procedure Complications (no. of patients) Revision/Other intervention Ristow et al 25 TSA and HA – – Colegate-Stone et al 4 Arthroscopic interventions, HA, and RTSA – – Kennon et al 13 Decompression Progression (6) ∗ Resurfacing (5) TSA (1) Resurfacing Stiffness (1) HA Glenoid wear (1) TSA Scapular insufficiency (1) RTSA TSA – – Harreld et al 10 Decompression – – Feeley et al 7 TSA vs. HA – – Lau et al 14 TSA – – HA Required blood transfusion (4) Medical management Sickle cell crises (2) Medical management Intra-op rotator cuff tear (1) Repaired during the same procedure Stiffness (1) Arthroscopic capsular release Septic loosening (1) Antibiotics suppression HA , hemiarthroplasty; RTSA , reverse total shoulder arthroplasty; TSA , total shoulder arthroplasty. ∗ All the patients who underwent small-diameter percutaneous decompression in the study by Kennon et al progressed and required revision surgeries.…”
Section: Resultsmentioning
confidence: 99%
“… 18 The primary risk factors for the development of HHAVN include the presence of femoral head AVN and genotype HbSC or HbS thalassemia, whereas the risk for lesion size, rate of progression, and joint collapse are attributed to the presence of the HbSS homozygous genotype. 3 , 13 , 22 …”
Background
Sickle cell disease is the leading etiology for atraumatic humeral head avascular necrosis worldwide. Treatment of this condition is not standardized, with only few studies evaluating clinical outcomes after surgical interventions. The aim of this study was to review the available evidence on the results of surgical intervention for humeral head avascular necrosis in the sickle cell disease population.
Methods
A systematic electronic search was conducted using PubMed (MEDLINE), EMBASE, and Cochrane Library databases. Relevant studies that reported the outcomes of surgical intervention for humeral head avascular necrosis for patients with sickle cell disease were reviewed. Outcome parameters were pain, range of motion, specific shoulder outcome scores, and complications.
Results
Six studies, three retrospective cohorts (2 level III and 1 level IV) and three case series (level IV), were included in this review. A total of forty-three patients with sickle cell disease, comprising forty-nine shoulders, underwent different surgical procedures. Surgical procedures were core decompression, arthroscopic intervention, humeral head resurfacing, shoulder hemiarthroplasty, and total shoulder arthroplasty.
Conclusion
Surgical intervention for humeral head avascular necrosis in patients with sickle cell disease is selected based on the osteonecrosis stage. In the precollapse stage, core decompression is regarded as the first surgical option. However, in the light of current evidence, it has not been confirmed to prevent or delay natural progression of the disease. Shoulder arthroplasty is reserved for late stages, which despite the fairly good outcomes, data for long-term implant survival and complications are not well documented.
“…1 ): three retrospective cohort studies (2 level III and 1 level IV evidence) 4 , 7 , 25 and three case series (level IV evidence). 10 , 13 , 14 In those six studies, forty-three (SCD) patients, comprising forty-nine shoulders, underwent different surgical interventions for HHAVN ( Table II ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…of shoulders (patients) Mean age (range) No. of shoulders (patients) % of SCD shoulders Ristow et al 25 2019 III Retrospective cohort TSA vs. HA 29 (25) 49 (16-77) 8 (6) 27.6 22 Colegate-Stone et al 4 2018 IV Retrospective cohort Arthroscopic intervention∗, HA, and RTSA 45 (45) 40 (21-62) 11 (11) 24.4 II, III, IV 11 Kennon et al 13 2016 IV Case series Decompression, resurfacing, HA, TSA, and RTSA 25 (20) 37 ± 15 13 (11) 52 I, II, III, IV 14 Harreld et al 10 2009 IV Case series Decompression 26 (15) 37 (15-50) 5 (3) 19.2 I, II 20 Feeley et al 7 2008 III Retrospective cohort TSA vs. HA 64 (64) 57 (46-77) 4 (4) 6.2 22 Lau et al. 14 2007 IV Case series TSA, HA 8 (8) 37 (25-47) 8 (8) 100 II, III, IV, V …”
Section: Resultsmentioning
confidence: 99%
“… Author Procedure Complications (no. of patients) Revision/Other intervention Ristow et al 25 TSA and HA – – Colegate-Stone et al 4 Arthroscopic interventions, HA, and RTSA – – Kennon et al 13 Decompression Progression (6) ∗ Resurfacing (5) TSA (1) Resurfacing Stiffness (1) HA Glenoid wear (1) TSA Scapular insufficiency (1) RTSA TSA – – Harreld et al 10 Decompression – – Feeley et al 7 TSA vs. HA – – Lau et al 14 TSA – – HA Required blood transfusion (4) Medical management Sickle cell crises (2) Medical management Intra-op rotator cuff tear (1) Repaired during the same procedure Stiffness (1) Arthroscopic capsular release Septic loosening (1) Antibiotics suppression HA , hemiarthroplasty; RTSA , reverse total shoulder arthroplasty; TSA , total shoulder arthroplasty. ∗ All the patients who underwent small-diameter percutaneous decompression in the study by Kennon et al progressed and required revision surgeries.…”
Section: Resultsmentioning
confidence: 99%
“… 18 The primary risk factors for the development of HHAVN include the presence of femoral head AVN and genotype HbSC or HbS thalassemia, whereas the risk for lesion size, rate of progression, and joint collapse are attributed to the presence of the HbSS homozygous genotype. 3 , 13 , 22 …”
Background
Sickle cell disease is the leading etiology for atraumatic humeral head avascular necrosis worldwide. Treatment of this condition is not standardized, with only few studies evaluating clinical outcomes after surgical interventions. The aim of this study was to review the available evidence on the results of surgical intervention for humeral head avascular necrosis in the sickle cell disease population.
Methods
A systematic electronic search was conducted using PubMed (MEDLINE), EMBASE, and Cochrane Library databases. Relevant studies that reported the outcomes of surgical intervention for humeral head avascular necrosis for patients with sickle cell disease were reviewed. Outcome parameters were pain, range of motion, specific shoulder outcome scores, and complications.
Results
Six studies, three retrospective cohorts (2 level III and 1 level IV) and three case series (level IV), were included in this review. A total of forty-three patients with sickle cell disease, comprising forty-nine shoulders, underwent different surgical procedures. Surgical procedures were core decompression, arthroscopic intervention, humeral head resurfacing, shoulder hemiarthroplasty, and total shoulder arthroplasty.
Conclusion
Surgical intervention for humeral head avascular necrosis in patients with sickle cell disease is selected based on the osteonecrosis stage. In the precollapse stage, core decompression is regarded as the first surgical option. However, in the light of current evidence, it has not been confirmed to prevent or delay natural progression of the disease. Shoulder arthroplasty is reserved for late stages, which despite the fairly good outcomes, data for long-term implant survival and complications are not well documented.
“…In this study, no wound infections, neurologic damage, or humeral head osteonecrosis or varus collapse were noted. This should be attributed to our rigorous sterile operation and postoperative care, as well as careful exposure and protection of the nerves intraoperatively [ 31 ]. Furthermore, the soft tissues around the humeral head were cautiously protected, with minimal interference with arterial supply to the humeral head and the fracture ends [ 32 ], subsequently decreasing the risk of humeral head avascular necrosis.…”
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