title: Small-diameter percutaneous decompression for osteonecrosis of the shoulder.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Harreld
authors.forename: German A
authors.initials: GA
authors.lastname: Marulanda
authors.forename: Slif D
authors.initials: SD
authors.lastname: Ulrich
authors.forename: David R
authors.initials: DR
authors.lastname: Marker
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010020:Osteonecrosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012307:Risk Factors; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult