Skip to main content

Advertisement

SpringerLink
Log in

Core decompression with autologous bone marrow aspirate injection in humeral head osteonecrosis in adults with sickle cell disease

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Sickle cell disease is often associated with osteonecrosis of the humeral head with a risk of progression to humeral head collapse. The aim of this study was to evaluate the clinical outcome and the effect on the necrosis evolution of humeral head core decompression with autologous bone marrow aspirate injection in these patients.

Methods

Forty shoulders in 23 patients were treated with core decompression with autologous concentrated iliac crest bone marrow aspirate injection. Patients were followed for a minimum of two  years (limits from 2 to 10 years). Functional outcomes metrics included the simple shoulder test (STT) and subjective shoulder value (SSV) as well as assessment of radiographic progression of disease.

Results

Shoulder function improved significantly at final follow-up. The STT improved by 2.9 points (p = 0.001) and the SVV improved by 15 % (p = 0.001). However, based on radiologic features, the intervention did not halt the radiographic progression of disease nor did it result in healing of the lesion. The benefits were mainly clinical with diminished pain and functional improvement.

Conclusion

Improvement in shoulder function was observed following core decompression and bone marrow aspirate injection in patients with sickle cell disease and early humeral head necrosis stages. The procedure should not be considered for grade 3 or greater disease and for asymptomatic cases whatever the grade. Given the lack of radiographic improvement observed in this study, further study in the context of prospective controlled trials should be undertaken before this intervention can be widely recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data and material are available on demand.

References

  1. Hernigou P, Bachir D, Galacteros F (2003) The natural history of symptomatic osteonecrosis in adults with sickle-cell disease. J Bone Joint Surg Am 85:500–504. https://doi.org/10.2106/00004623-200303000-00016

    Article  CAS  PubMed  Google Scholar 

  2. Cruess RL (1978) Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip. Clin Orthop Relat Res:86–93

  3. Hasan SS, Romeo AA (2002) Nontraumatic osteonecrosis of the humeral head. J Shoulder Elbow Surg 11:281–298. https://doi.org/10.1067/mse.2002.124347

    Article  PubMed  Google Scholar 

  4. Poignard A, Flouzat-Lachaniette CH, Amzallag J, Glacteros F, Hernigou P (2012) The natural progression of symptomatic humeral head osteonecrosis in adults with sickle cell disease. J Bone Joint Surg Am 94:156–162. https://doi.org/10.2106/JBJS.J.00919

    Article  PubMed  Google Scholar 

  5. LaPorte DM, Mont MA, Mohan V, Pierre-Jacques H, Jones LC, Hungerford DS (1998) Osteonecrosis of the humeral head treated by core decompression. Clin Orthop Relat Res:254–260. https://doi.org/10.1097/00003086-199810000-00027

  6. Hernigou P, Dubory A, Homma Y, Guissou I, Flouzat-Lachaniette CH, Chevallier N, Rouard H (2018) Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: a thirty year follow-up prospective randomized study of one hundred and twenty five adult patients. Int Orthop 42:1639–1649. https://doi.org/10.1007/s00264-018-3941-8

    Article  PubMed  Google Scholar 

  7. Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16:717–721. https://doi.org/10.1016/j.jse.2007.02.123

    Article  PubMed  Google Scholar 

  8. Godfrey J, Hamman R, Lowenstein S, Briggs K, Kocher M (2007) Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type. J Shoulder Elbow Surg 16:260–267. https://doi.org/10.1016/j.jse.2006.07.003

    Article  PubMed  Google Scholar 

  9. Colegate-Stone TJ, Aggarwal S, Karuppaiah K, Tavakkolizadeh A, Sinha J, Reichert IL (2018) The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease-a cohort review. Int Orthop 42:1651–1659. https://doi.org/10.1007/s00264-018-3957-0

    Article  PubMed  Google Scholar 

  10. Hernigou P, Beaujean F (2002) Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res:14–23. https://doi.org/10.1097/00003086-200212000-00003

  11. Hernigou P, Guerin G, Homma Y, Dubory A, Chevallier N, Rouard H, Flouzat-Lachaniette CH (2018) History of concentrated or expanded mesenchymal stem cells for hip osteonecrosis: is there a target number for osteonecrosis repair? Int Orthop 42:1739–1745. https://doi.org/10.1007/s00264-018-4000-1

    Article  PubMed  Google Scholar 

  12. Hernigou P, Flouzat-Lachaniette CH, Roussignol X, Poignard A (2010) The natural progression of shoulder osteonecrosis related to corticosteroid treatment. Clin Orthop Relat Res 468:1809–1816. https://doi.org/10.1007/s11999-009-1094-1

    Article  PubMed  Google Scholar 

  13. L’Insalata JC, Pagnani MJ, Warren RF, Dines DM (1996) Humeral head osteonecrosis: clinical course and radiographic predictors of outcome. J Shoulder Elbow Surg 5:355–361. https://doi.org/10.1016/s1058-2746(96)80066-8

    Article  PubMed  Google Scholar 

  14. Mont MA, Payman RK, Laporte DM, Petri M, Jones LC, Hungerford DS (2000) Atraumatic osteonecrosis of the humeral head. J Rheumatol 27:1766–1773

    CAS  PubMed  Google Scholar 

  15. Kennon JC, Smith JP, Crosby LA (2016) Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. J Shoulder Elbow Surg 25:1442–1448. https://doi.org/10.1016/j.jse.2016.01.022

    Article  PubMed  Google Scholar 

  16. Mont MA, Maar DC, Urquhart MW, Lennox D, Hungerford DS (1993) Avascular necrosis of the humeral head treated by core decompression. A retrospective review. J Bone Joint Surg Br 75:785–788

    Article  CAS  Google Scholar 

  17. Loebenberg MI, Plate AM, Zuckerman JD (1999) Osteonecrosis of the humeral head. Instr Course Lect 48:349–357

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr Peter Lapner for his assistance in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, 51 avenue du Marechal de Lattre de Tassigny, 94010, Creteil, France

    Gilles Guerin

  2. Sickle cell referral center, UPEC, Institut Mondor Recherche Biomédical (IMRB), Institut national de la Santé et de la Recherche médicale (INSERM) U955, APHP, Henri Mondor teaching hospital, DHU A-TVB, 94010, Creteil, France

    Anoosha Habibi

  3. Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, Creteil, France

    Philippe Hernigou

  4. Almaviva Santé, Clinique Arago, Paris, France

    Sebastien Zilber

Authors
  1. Gilles Guerin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anoosha Habibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philippe Hernigou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastien Zilber
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Gilles Guerin. The first draft of the manuscript was written by Sebastien Zilber who is the designer of the study. Anoosha Habibi and Philippe Hernigou reviewed and edited the manuscript. All authors read and approved the revised manuscript.

Corresponding author

Correspondence to Sebastien Zilber.

Ethics declarations

This is an observational study. The Clinique Arago (Almaviva) research committee has confirmed that no ethical approval is required. Informed consent was obtained from all individual participants included in the study

Consent for publication

Not applicable

Conflict of interest

The authors declare that they no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guerin, G., Habibi, A., Hernigou, P. et al. Core decompression with autologous bone marrow aspirate injection in humeral head osteonecrosis in adults with sickle cell disease. International Orthopaedics (SICOT) 45, 1257–1261 (2021). https://doi.org/10.1007/s00264-021-04962-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-04962-1

Keywords

Search

Navigation