Original Research
Small-Diameter Percutaneous Decompression for Osteonecrosis of the Shoulder
Am J Orthop. 2009 July;38(7):348-354
Author and Disclosure Information
Kevin L. Harreld, MD, German A. Marulanda, MD, Slif D. Ulrich, MD, David R. Marker, BS, Thorsten M. Seyler, MD, and Michael A. Mont, MD
Dr. Harreld is Resident Physician, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
Dr. Marulanda is Resident Physician, Department of Orthopaedics and Sports Medicine, University of South Florida College of Medicine, Tampa, Florida.
Dr. Ulrich is Resident Physician, Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland.
Mr. Marker is Medical Student, Johns Hopkins School of Medicine, Baltimore, Maryland.
Dr. Seyler is Resident Physician, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
Dr. Mont is Director, Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Core decompression of the humeral head has previously been used as a joint- preserving procedure for treatment of symptomatic osteonecrosis of the shoulder. In this article, we describe a new decompression technique, which involves multiple small-diameter (3-mm) percutaneous perforations.
In our study population (early-stage disease), shoulder arthroplasty was avoided in all 15 patients (26 shoulders) for a mean follow-up of 32 months (range, 24-41 months). Of the 26 shoulders, 25 had successful clinical and functional outcomes (University of California Los Angeles shoulder score, >24 points), and 1 showed radiographic progression of the disease but has not needed further operative treatment.
We compared our decompression results with those of a nonoperative historical control group, identified through a literature search. There was a 48% (143/299) rate of progression to arthroplasty in the control group at a follow-up ranging from 2 to 4.5 years.
This outpatient, percutaneous perforations technique appears to be a low-morbidity method for relieving symptoms and deferring shoulder arthroplasty in patients with symptomatic osteonecrosis of the humeral head.