Our Summary

This research paper is about a rare condition known as humeral head atraumatic avascular necrosis, which affects the shoulder’s humerus bone, particularly in young and active individuals. The Cruess radiographic classification is used to determine the severity of the condition and to decide the most suitable surgical treatment.

Different surgical treatments are available, some aim to preserve the existing bone (conservative treatments) such as core decompression, bone grafting, and arthroscopic debridement (a minimally invasive surgical procedure), while others involve prosthetic replacements such as resurfacing, hemiarthroplasty (partial shoulder replacement), or total shoulder replacement.

The paper suggests that for less severe cases, core decompression may be a good option as it can be effective and does not limit the possibility of any future surgeries. For more severe cases, prosthetic replacements can lead to good results. If the glenoid cartilage (part of the shoulder joint) is intact, hemiarthroplasty may be the best option as it has fewer complications and better long-term outcomes than a complete shoulder replacement.

FAQs

  1. What is humeral head atraumatic avascular necrosis and who does it typically affect?
  2. What are the different surgical treatments for humeral head atraumatic avascular necrosis?
  3. How does the severity of humeral head avascular necrosis influence the choice of surgical treatment?

Doctor’s Tip

One helpful tip a doctor might tell a patient about shoulder replacement is to follow post-operative rehabilitation and physical therapy recommendations closely to ensure optimal recovery and range of motion. It is important to work with a physical therapist to strengthen the shoulder muscles and regain function gradually. This will help prevent complications and improve overall outcomes after surgery.

Suitable For

Patients who are typically recommended for shoulder replacement include those with humeral head atraumatic avascular necrosis, especially young patients with a high functional demand. The severity of the avascular necrosis is assessed using the Cruess classification, which helps guide surgical indications. Conservative treatments such as core decompression, bone grafting, and arthroscopic debridement may be considered for low-grade avascular necrosis, while prosthetic replacements such as resurfacing, hemiarthroplasty, or total arthroplasty are typically recommended for high-grade avascular necrosis. Hemiarthroplasty may be preferred if the glenoid cartilage is intact, as it has lower rates of wear complications and better long-term outcomes than total shoulder arthroplasty.

Timeline

  • Before shoulder replacement:
  1. Patient experiences chronic shoulder pain, stiffness, and limited range of motion.
  2. Patient undergoes imaging tests such as X-rays, MRI, or CT scans to determine the extent of damage to the shoulder joint.
  3. Patient may undergo conservative treatments such as physical therapy, medications, or corticosteroid injections to manage symptoms.
  4. If conservative treatments are ineffective, patient may be recommended for surgical intervention.
  • After shoulder replacement:
  1. Patient undergoes shoulder replacement surgery, which can be either resurfacing, hemiarthroplasty, or total arthroplasty.
  2. Patient undergoes post-operative rehabilitation and physical therapy to regain strength, range of motion, and function in the shoulder.
  3. Patient may experience temporary pain, swelling, and stiffness after surgery, which gradually improves with time.
  4. Patient gradually returns to normal activities and experiences improved shoulder function and reduced pain compared to before surgery.
  5. Long-term follow-up appointments are scheduled to monitor the success of the shoulder replacement and address any potential complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with shoulder replacement surgery?
  2. What is the expected recovery time and rehabilitation process after shoulder replacement surgery?
  3. How long can I expect the shoulder replacement to last before needing a revision surgery?
  4. Will I need physical therapy after the surgery, and if so, for how long?
  5. Are there any restrictions or limitations on activities that I should be aware of after the surgery?
  6. How successful is shoulder replacement surgery in relieving pain and improving function?
  7. What type of shoulder replacement procedure do you recommend for my specific condition?
  8. How many shoulder replacement surgeries have you performed, and what is your success rate?
  9. What are the alternatives to shoulder replacement surgery, and why do you recommend this procedure for me?
  10. Are there any lifestyle changes or modifications that I should consider before and after the surgery to optimize the outcome?

Reference

Authors: Le Coz P, Herve A, Thomazeau H. Journal: Morphologie. 2021 Jun;105(349):155-161. doi: 10.1016/j.morpho.2021.02.007. Epub 2021 Mar 20. PMID: 33757693