The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease-a cohort review

Abstract

Purpose: A formalised, universally accepted, radiological staging system of gleno-humeral joint osteonecrosis (ON) is lacking. Consequently, there is absence of a standardised management strategy. The aim is to propose a simple radiological staging system of gleno-humeral joint ON based on principles of the Association Research Circulation Osseous (ARCO) Society and review of clinical practice.

Methods: A radiographic and clinical review of 45 patients with haematological-induced gleno-humeral ON was performed. The related management plans were analysed and categorised.

Results: Analysis divided the disease into stages 0-4. Non-interventional management was the first-line treatment in stages 1-2. If unsuccessful, arthroscopic core decompression was performed. Patients with stages 3-4 were initially managed conservatively. If unsuccessful, in younger patients, arthroscopic joint debridement and capsular release was trialled. In older patients, or where this approach failed, shoulder arthroplasty was advised.

Conclusion: The simple radiological classification assessed is useful to the provision of a standardised staged management strategy of gleno-humeral ON.

Keywords: Classification; Osteonecrosis; Shoulder joint; Sickle cell disease.