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

Abstract

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.

Bilateral Humeral Head Avascular Necrosis: A Rare Presentation in Sickle Cell Trait

“…However, according to the information that is currently available, it has not been proven to stop or slow the usual development and progression of the disease. Despite the fact that shoulder arthroplasty typically has good outcomes in its later stages, data on long-term implant survival and issues are scarce [ 14 , 15 ].…”

Humeral Head Resurfacing for Isolated Primary Humeral Osteoarthritis With a Large Chondral Defect

“…Large humeral head chondral lesions have been shown to result from a number of etiologies including trauma, previous surgery, avascular necrosis (AVN), osteoarthritis, or idiopathic chondrolysis. [1][2][3] Such lesions, which are typically located on the humeral head, are difficult to diagnose via preoperative clinical examination and imaging techniques and are often discovered during arthroscopy. 1,4 Although joint-preservation techniques are sometimes indicated in young patients without arthritis, shoulder arthroplasty traditionally has been the treatment of choice to treat isolated, large chondral defects of the humeral head in older patients.…”