Gilles Guerin1, Anoosha Habibi2, Philippe Hernigou3, Sebastien Zilber4. 1. Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, 51 avenue du Marechal de Lattre de Tassigny, 94010, Creteil, France. 2. Sickle cell referral center, UPEC, Institut Mondor Recherche Biomédical (IMRB), Institut national de la Santé et de la Recherche médicale (INSERM) U955, APHP, Henri Mondor teaching hospital, DHU A-TVB, 94010, Creteil, France. 3. Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, Creteil, France. 4. Almaviva Santé, Clinique Arago, Paris, France. sebastien.zilber@wanadoo.fr.
Abstract
PURPOSE: Sickle cell disease is often associated with osteonecrosis of the humeral head with a risk of progression to humeral head collapse. The aim of this study was to evaluate the clinical outcome and the effect on the necrosis evolution of humeral head core decompression with autologous bone marrow aspirate injection in these patients. METHODS: Forty shoulders in 23 patients were treated with core decompression with autologous concentrated iliac crest bone marrow aspirate injection. Patients were followed for a minimum of two years (limits from 2 to 10 years). Functional outcomes metrics included the simple shoulder test (STT) and subjective shoulder value (SSV) as well as assessment of radiographic progression of disease. RESULTS: Shoulder function improved significantly at final follow-up. The STT improved by 2.9 points (p = 0.001) and the SVV improved by 15 % (p = 0.001). However, based on radiologic features, the intervention did not halt the radiographic progression of disease nor did it result in healing of the lesion. The benefits were mainly clinical with diminished pain and functional improvement. CONCLUSION: Improvement in shoulder function was observed following core decompression and bone marrow aspirate injection in patients with sickle cell disease and early humeral head necrosis stages. The procedure should not be considered for grade 3 or greater disease and for asymptomatic cases whatever the grade. Given the lack of radiographic improvement observed in this study, further study in the context of prospective controlled trials should be undertaken before this intervention can be widely recommended.
PURPOSE:Sickle cell disease is often associated with osteonecrosis of the humeral head with a risk of progression to humeral head collapse. The aim of this study was to evaluate the clinical outcome and the effect on the necrosis evolution of humeral head core decompression with autologous bone marrow aspirate injection in these patients. METHODS: Forty shoulders in 23 patients were treated with core decompression with autologous concentrated iliac crest bone marrow aspirate injection. Patients were followed for a minimum of two years (limits from 2 to 10 years). Functional outcomes metrics included the simple shoulder test (STT) and subjective shoulder value (SSV) as well as assessment of radiographic progression of disease. RESULTS: Shoulder function improved significantly at final follow-up. The STT improved by 2.9 points (p = 0.001) and the SVV improved by 15 % (p = 0.001). However, based on radiologic features, the intervention did not halt the radiographic progression of disease nor did it result in healing of the lesion. The benefits were mainly clinical with diminished pain and functional improvement. CONCLUSION: Improvement in shoulder function was observed following core decompression and bone marrow aspirate injection in patients with sickle cell disease and early humeral head necrosis stages. The procedure should not be considered for grade 3 or greater disease and for asymptomatic cases whatever the grade. Given the lack of radiographic improvement observed in this study, further study in the context of prospective controlled trials should be undertaken before this intervention can be widely recommended.
Authors: Philippe Hernigou; Arnaud Dubory; Yasuhiro Homma; Isaac Guissou; Charles Henri Flouzat Lachaniette; Nathalie Chevallier; Hélène Rouard Journal: Int Orthop Date: 2018-05-09 Impact factor: 3.075