Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery. Arthroscopic shoulder surgery has become a popular procedure in the last two decades. It is generally regarded as a safe procedure, with few risks. Recently, however, some disastrous complications, including glenohumeral chondrolysis and osteonecrosis of the humeral head after an arthroscopic procedure, have been reported. 1-4) Glenohumeral chondrolysis after arthroscopic shoulder surgery has been widely reported, and many causes were suggested, including local anesthesia through a pain pump, radiofrequency device, and so on. 1) However little is known about post-arthroscopic humeral head necrosis. To the best of the author's knowledge, there are only three reports in English literature on humeral head osteonecrosis after such surgery. 2-4) Despite its rarity, humeral head osteonecrosis after arthroscopic shoulder surgery requires early diagnosis and proper treatment to prevent development into a serious glenohumeral arthrosis. We report on a case of osteonecrosis of the humeral head after arthroscopic Bankart and rotator cuff repair which showed rapid progression with a review of the literature.
Case ReportA 66-year-old right-handed female patient was referred to our clinic with complaints of pain and limited motion in her right shoulder after arthroscopic surgery at an outside facility. Meticulous history taking revealed that the patient had fallen from a height of about one meter about seven months earlier, and she was diagnosed with an anterior shoulder dislocation with bony Bankart lesion (Fig. 1A, B), and rotator cuff tear, however the marrow signal of her proximal humerus was nonspecific on preoperative magnetic resonance imaging (MRI) (Fig. 1C, D). Subsequently she underwent arthroscopic Bankart and double row rotator cuff repair with bioabsorbable suture anchors (3 anchors for bony Bankart lesion, 4 anchors for rotator cuff tear). Postoperative MRI taken one week later showed that both lesions were well repaired (Fig. 2). According to the medical records from the previous hospital, she had started performing range-ofmotion exercises from 6 weeks postoperatively and presented 90 degrees of active forward flexion and 40 degrees of active