Core decompression of osteonecrosis
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Core decompression is the first-line surgical option for symptomatic and low-grade osteonecrosis of the femoral or humeral head. Core decompression is a treatment for improvingimproves symptoms and preventingprevents progression and humeralfemora/humeral head collapse (crescent sign). Without treatment, the osteonecrosis of the humeral head progress to humeral head collapse on an average of 6 years after the onset of pain.
Core decompression reducesby reducing subchondral bone marrow pressure and promotespromoting neovascularisation, with healthy new bone formation.
With this procedure, the The overall success rate of this procedure is high with pain relief and improved function in the patient. However, the success rate decreases as the stage of the disease worsens.
Procedure
The arthroscopic lateral cortical perforation technique is a simple method for performing the decompression.
Advantages and disadvantages
Advantages
In patients with early stage disease who have failed conservative treatments, prevents progression or delays arthroplastyarthroscopy can aid in staging and address associated pathology such as removal of loose bodies or debridement of chondral flaps.
Disadvantages
The proximity of the anterior branch of the axillary nerve places it at greater risk of injury during decompression of the humeral head.
Treatment and prognosis
In stage I and stage II osteonecrosis (Cruess classification of osteonecrosis of humeral head), core decompression is indicated to reverse early radiographic changes and prevent progression and collapse. With stage IV and stage V osteonecrosis, the bone changes are irreversible and is better shoulder arthroplasty.
See also
History and etymology
Mont et al. 1993 University of California, Los Angeles (UCLA) with good to excellent results for stage I or stage II (Ficat and Arlet classification of osteonecrosis of the femoral head) core decompression of the AVN humeral head without progression to TSA.
-<p><strong>Core decompression</strong> is the first-line surgical option for symptomatic and low-grade <a href="/articles/osteonecrosis-of-the-humeral-head" title="Osteonecrosis of the humeral head">osteonecrosis of the humeral head</a>. Core decompression is a treatment for improving symptoms and preventing progression and humeral head collapse (<a href="/articles/crescent-sign-osteonecrosis" title="Crescent sign (osteonecrosis)">crescent sign</a>). Without treatment, the<a href="/articles/osteonecrosis-of-the-humeral-head" title=" osteonecrosis of the humeral head"> osteonecrosis of the humeral head</a> progress to humeral head collapse on an average of 6 years after the onset of pain.</p><p>Core decompression reduces subchondral bone marrow pressure and promotes neovascularisation, with healthy new bone formation.</p><p>With this procedure, the overall success rate is high with pain relief and improved function in the patient. However, the success rate decreases as the stage of the disease worsens.</p><h4>Procedure</h4><p>The arthroscopic lateral cortical perforation technique is a simple method for performing the decompression.</p><h4>Advantages and disadvantages</h4><h5>Advantages</h5><ul>-<li><p>In patients with early stage disease who have failed conservative treatments, prevents progression or delays arthroplasty</p></li>-<li><p>arthroscopy can aid in staging and address associated pathology such as removal of loose bodies or debridement of chondral flaps.</p></li>-</ul><h5>Disadvantages</h5><p>The proximity of the anterior branch of the axillary nerve places it at greater risk of injury during decompression of the humeral head.</p><h4>Treatment and prognosis</h4><p>In stage I and stage II osteonecrosis (<a href="/articles/cruess-classification-of-humeral-head-osteonecrosis" title="Cruess classification of osteonecrosis of humeral head">Cruess classification of osteonecrosis of humeral head</a>), core decompression is indicated to reverse early radiographic changes and prevent progression and collapse. With stage IV and stage V osteonecrosis, the bone changes are irreversible and is better <a href="/articles/shoulder-arthroplasty" title="shoulder arthroplasty.--">shoulder arthroplasty.</a></p><h4>See also</h4><ul>-<li><p><a href="/articles/reverse-shoulder-total-shoulder-arthroplasty-rtsa" title="Reverse shoulder total shoulder arthroplasty (RTSA)">Reverse shoulder total shoulder arthroplasty (RTSA)</a></p></li>-<li><p><a href="/articles/cruess-classification-of-humeral-head-osteonecrosis" title="Cruess classification of osteonecrosis of humeral head">Cruess classification of osteonecrosis of humeral head</a></p></li>-<li><p><a href="/articles/crescent-sign-of-arterial-dissection" title="Crescent sign">Crescent sign</a></p></li>-</ul><h4>History and etymology</h4><p>Mont et al. 1993 University of California, Los Angeles (UCLA) with good to excellent results for stage I or stage II (<a href="/articles/ficat-and-arlet-classification-of-osteonecrosis-of-the-femoral-head" title="Ficat and Arlet classification of osteonecrosis of the femoral head">Ficat and Arlet classification of osteonecrosis of the femoral head</a>) core decompression of the AVN humeral head without progression to TSA.</p>- +<p><strong>Core decompression</strong> is the first-line surgical option for symptomatic and low-grade <a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a> of the <a href="/articles/osteonecrosis-of-the-femoral-head" title="Osteonecrosis of the femoral head">femoral</a> or <a href="/articles/osteonecrosis-of-the-humeral-head" title="Osteonecrosis of the humeral head">humeral head</a>. Core decompression improves symptoms and prevents progression and femora/humeral head collapse by reducing subchondral bone marrow pressure and promoting neovascularisation with new bone formation. The overall success rate of this procedure is high with pain relief and improved function in the patient. However, the success rate decreases as the stage of the disease worsens.</p>
References changed:
- 1. McClatchy S, Schryver E, Field L. Arthroscopically Assisted Humeral Head Decompression for Avascular Necrosis: Lateral Cortical Perforation Technique. Arthroscopy Techniques. 2022;11(4):e505-9. <a href="https://doi.org/10.1016/j.eats.2021.11.016">doi:10.1016/j.eats.2021.11.016</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35493042">Pubmed</a>
- 2. Mont M, Maar D, Urquhart M, Lennox D, Hungerford D. Avascular Necrosis of the Humeral Head Treated by Core Decompression. A Retrospective Review. The Journal of Bone and Joint Surgery British Volume. 1993;75-B(5):785-8. <a href="https://doi.org/10.1302/0301-620x.75b5.8376440">doi:10.1302/0301-620x.75b5.8376440</a>
- 3. Pierce T, Jauregui J, Elmallah R, Lavernia C, Mont M, Nace J. A Current Review of Core Decompression in the Treatment of Osteonecrosis of the Femoral Head. Curr Rev Musculoskelet Med. 2015;8(3):228-32. <a href="https://doi.org/10.1007/s12178-015-9280-0">doi:10.1007/s12178-015-9280-0</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26045085">Pubmed</a>
- S. Gray McClatchy, Eric M. Schryver, Larry D. Field, Arthroscopically Assisted Humeral Head Decompression for Avascular Necrosis: Lateral Cortical Perforation Technique, Arthroscopy Techniques, Volume 11, Issue 4, 2022, Pages e505-e509, ISSN 2212-6287, https://doi.org/10.1016/j.eats.2021.11.016.
- Mont M, Maar D, Urquhart M, Lennox D, Hungerford D. Avascular necrosis of the humeral head treated by core decompression. A retrospective review. J Bone Joint Surg Br. 1993;75-B(5):785-788. doi:10.1302/0301-620X.75B5.8376440
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