title: Surgical management of osteonecrosis of the humeral head: a systematic review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy. e.franceschetti@unicampus.it.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Franceschetti
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Paciotti
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Torre
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Kristian
authors.initials: K
authors.lastname: Samuelsson
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jón
authors.initials: J
authors.lastname: Karlsson
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D019299:Decompression, Surgical; D062785:Hemiarthroplasty; D006801:Humans; D058430:Humeral Head / Q000601:surgery*; D010020:Osteonecrosis / Q000601:surgery*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012189:Retrospective Studies; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome
keywords: Avascular necrosis; Core decompression; Humeral head; Osteonecrosis; Shoulder surgery; Systematic review