The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease—a cohort review

Abstract

Purpose A formalised, universally accepted, radiological staging system of gleno-humeral joint osteonecrosis (ON) is lacking. Consequently, there is absence of a standardised management strategy. The aim is to propose a simple radiological staging system of gleno-humeral joint ON based on principles of the Association Research Circulation Osseous (ARCO) Society and review of clinical practice. Methods A radiographic and clinical review of 45 patients with haematological-induced gleno-humeral ON was performed. The related management plans were analysed and categorised. Results Analysis divided the disease into stages 0-4. Non-interventional management was the first-line treatment in stages 1-2. If unsuccessful, arthroscopic core decompression was performed. Patients with stages 3-4 were initially managed conservatively. If unsuccessful, in younger patients, arthroscopic joint debridement and capsular release was trialled. In older patients, or where this approach failed, shoulder arthroplasty was advised. Conclusion The simple radiological classification assessed is useful to the provision of a standardised staged management strategy of gleno-humeral ON.

Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification

“…Stage 5 is when the glenoid has developed articular changes due to joint incongruity. Other authors have proposed similar classifications 4,38 .There is a correlation between different exams and histology (Fig. 12).…”

Surgical treatment of humeral head avascular necrosis in patients with sickle cell disease: a systematic review

“…Ultimately, six studies were included in this review ( Fig. 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 ).…”

“…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 …”

“… 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.…”

“…Arthroscopic intervention was mentioned in 1 study 4 ; the study lacks objective assessment. A single subjective outcome measure was used: VAS for pain with no proper statistical significance parameters.…”