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

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Osteonecrosis of the humeral head is a rare diagnosis. The aim of this systematic review was to identify published studies and analyse the best clinical evidence available related to the surgical management of osteonecrosis of the humeral head.

Methods

A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. Published studies that reported the outcomes for adult patients treated surgically for osteonecrosis of the humeral head were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was followed.

Results

Twelve studies were included: five prospective case series and seven retrospective case series. A total of 309 patients, comprising 382 shoulders, were included. Three main surgical procedures were evaluated: core decompression, hemi-arthroplasty and total shoulder arthroplasty.

Conclusions

Based on the current available data, core decompression is a safe and effective option for treating low-grade osteonecrosis of the humeral head, while hemi-arthroplasty and total shoulder arthroplasty should be considered for high-grade osteonecrosis. More studies and better-designed trials are needed in order to enrich the evidence and enable researchers to draw stronger conclusions. Since osteonecrosis is an uncommon, though challenging disease, a proper knowledge of its treatment is needed.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy

    Francesco Franceschi, Edoardo Franceschetti, Michele Paciotti, Guglielmo Torre, Rocco Papalia & Vincenzo Denaro

  2. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Kristian Samuelsson & Jón Karlsson

Authors
  1. Francesco Franceschi
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  2. Edoardo Franceschetti
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  3. Michele Paciotti
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  4. Guglielmo Torre
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  8. Vincenzo Denaro
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Correspondence to Edoardo Franceschetti.

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Franceschi, F., Franceschetti, E., Paciotti, M. et al. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc 25, 3270–3278 (2017). https://doi.org/10.1007/s00167-016-4169-z

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  • DOI: https://doi.org/10.1007/s00167-016-4169-z

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