Atraumatic osteonecrosis of the humeral head

Objective. To define the epidemiology, clinical and radiographic presentati on, treatment, and prognosis of atraumatic osteonecrosis of the humeral hea d. Methods. Of the 1056 patients managed for osteonecrosis of any joint betwee n July 1, 1974, and December 1, 1996, 127 shoulders in 73 patients were tre ated for atraumatic osteonecrosis of the proximal humerus. Clinical and rad iographic characterization of this patient cohort was performed. Results. At presentation, there were 47 women and 26 men with a mean age of 41 years (range 20-60). Numerous associated factors were noted: alcohol us e (38%), moderate smoking (30%), asthma (8%), and nephrosis (3%). A cortico steroid association was noted in 60 patients (82%) and 42 of the patients ( 58%) had an immunocompromising disease. The severity of humeral head osteon ecrosis did not correlate with dose or duration of corticosteroid therapy. According to the modified Ficat and Arlet radiographic staging system, ther e were 20 shoulders with Stage I disease, 55 shoulders with stage II diseas e, and 52 shoulders with Stage III or IV disease. Seventy-Four of the shoul ders treated with core decompression (78%) had good to excellent clinical o utcomes at a mean followup of 6 years (range 2-21). Fourteen of the 16 pati ents (88%) treated with hemiarthroplasty or total shoulder arthroplasty wer e clinically successful at a mean followup 41 years (range 2-11). Conclusion. We observed a low incidence of humeral head involvement in the osteonecrosis patient cohort (7% of all osteonecrosis patients), and a high incidence of corticosteroid use (82%), hip involvement (81%), and bilatera l disease (74%). Osteonecrosis of the humeral head should be suspected in p atients presenting with shoulder pain and a history of osteonecrosis in oth er joints. I-lip screening for osteonecrosis is advocated in patients with shoulder involvement. Early detection of shoulder osteonecrosis may permit a more conservative, joint-sparing approach as an alternative to surgical m anagement.