Surgical management of osteonecrosis of the humeral head: a systematic review

Franceschi, Francesco; Franceschetti, Edoardo; Paciotti, Michele; Torre, Guglielmo; Samuelsson, Kristian; Papalia, Rocco; Karlsson, Jón; Denaro, Vincenzo

doi:10.1007/s00167-016-4169-z

Cited by 43 publications

(30 citation statements)

References 23 publications

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“…Once the affected hard tissue has broken down there is no therapy other than removing the dead bone and, if sufficient bone remains, placing a metal implant. When osteonecrosis is diagnosed in its early stages, drilling into the affected bone (known as core decompression surgery 10 ) is sometimes employed in an effort to stimulate blood flow 11 . Drilling is occasionally supplemented with growth factors 12 .…”

Section: Introductionmentioning

confidence: 99%

WNT-activated bone grafts repair osteonecrotic lesions in aged animals

Salmon

Liu

Shen

et al. 2017

Sci Rep

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The Wnt pathway is a new target in bone therapeutic space. WNT proteins are potent stem cell activators and pro-osteogenic agents. Here, we gained insights into the molecular and cellular mechanisms responsible for liposome-reconstituted recombinant human WNT3A protein (L-WNT3A) efficacy to treat osteonecrotic defects. Skeletal injuries were coupled with cryoablation to create non-healing osteonecrotic defects in the diaphysis of the murine long bones. To replicate clinical therapy, osteonecrotic defects were treated with autologous bone graft, which were simulated by using bone graft material from syngeneic ACTB-eGFP-expressing mice. Control osteonecrotic defects received autografts alone; test sites received autografts treated ex vivo with L-WNT3A. In vivo µCT monitored healing over time and immunohistochemistry were used to track the fate of donor cells and assess their capacity to repair osteonecrotic defects according to age and WNT activation status. Collectively, analyses demonstrated that cells from the autograft directly contributed to repair of an osteonecrotic lesion, but this contribution diminished as the age of the donor increased. Pre-treating autografts from aged animals with L-WNT3A restored osteogenic capacity to autografts back to levels observed in autografts from young animals. A WNT therapeutic approach may therefore have utility in the treatment of osteonecrosis, especially in aged patients.

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Section: Introductionmentioning

confidence: 99%

WNT-activated bone grafts repair osteonecrotic lesions in aged animals

Salmon

Liu

Shen

et al. 2017

Sci Rep

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“…Previous studies have assessed a variety of surgical and non-surgical methods in the management of glenohumeral ON [5]. However, whilst these studies sought to assess the clinical efficacy of a particular treatment protocol, they often failed to target to a specific stage of gleno- humeral ON disease.…”

Section: Discussionmentioning

confidence: 99%

“…Shoulder arthroplasty was found to have a role in Stage 4 patients with advanced osteoarthritic changes and less age-based activity demands and expectations. Previous systemic reviews into the management of gleno-humeral ON are limited [5]. A variety of different surgical techniques have been described to deliver improved clinical outcomes for patients with symptomatic ON by a number of authors [1,3,8,9,14,19,21].…”

Section: Discussionmentioning

confidence: 99%

“…Humeral head core decompression aims to reduce intra-osseous pressure to restore the normal vascular flow. The outcomes following humeral head core decompression have historically shown a positive effect in patients with early stage disease [5,8,13,16] with symptomatic benefit beyond five years following treatment. Core decompression can be performed open or with arthroscopic assistance.…”

Section: Discussionmentioning

confidence: 99%

“…Arthroscopic decompression and debridement has been shown to have limited benefits as the disease stages progress [7]. Arthroplasty is generally reserved for patients with more advanced conditions [3,5,9,19,21]. The approach advocated in this present study is based on 85% of patients at Stage 1-2 having conservative treatment and 14% undergoing arthroscopic core decompression.…”

Section: Discussionmentioning

confidence: 99%

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

Colegate-Stone

Aggarwal

Karuppaiah

et al. 2018

International Orthopaedics (SICOT)

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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.

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