Toby J Colegate-Stone1, Saurabh Aggarwal2, Karthik Karuppaiah1, Adel Tavakkolizadeh1, Joydeep Sinha1, Ines Lh Reichert3. 1. Department of Trauma & Orthopaedics, Kings College Hospital Foundation Trust, Denmark Hill, London, SE5 9RS, UK. 2. Department of Trauma & Orthopaedics, Princess Royal University Hospital, Orpington, UK. 3. Department of Trauma & Orthopaedics, Kings College Hospital Foundation Trust, Denmark Hill, London, SE5 9RS, UK. ines.reichert@kcl.ac.uk.
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.
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.
Authors: Kevin L Harreld; German A Marulanda; Slif D Ulrich; David R Marker; Thorsten M Seyler; Michael A Mont Journal: Am J Orthop (Belle Mead NJ) Date: 2009-07
Authors: Brian T Feeley; Stephen Fealy; David M Dines; Russell F Warren; Edward V Craig Journal: J Shoulder Elbow Surg Date: 2008-07-25 Impact factor: 3.019