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Atraumatic Avascular Necrosis of the Humeral Head: Clinical and Radiographic Classification

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Shoulder Arthroplasty

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Summary

This retrospective study reports the clinical and radiographic appearances of 43 shoulders which were operated on for avascular necrosis (excluding posttraumatic AVN). The aetiologies were comparable to those in the literature. The most frequent cause after idiopathic necrosis was secondary to corticosteroid therapy. The overall clinical picture is unspecific and does not match the radiographic appearance. The natural history is variable. The radiographic appearance, described in five stages, is characteristic for the lesion. The necrosis always appeared in the same area of the upper part of the humeral head opposite the superior pole of the glenoid; areas of major mechanical forces. In all cases, except for radiation necrosis, the articular summit of the humeral head in contact with the greater tuberosity was conserved. This specific radiographic sign allows the particular clinico-radiographic form occurring in elderly women (over 70 years) which presents with rapid, massive collapse of the humeral head to be linked in with avascular necrosis. This form of necrosis is debatable in marking the border line limits with the rapidly destructive arthropathies. Radiation necrosis, occurring late after irradiation, is differentiated by its histology (no evidence of repair) and its radiographic appearance (generalised head necrosis and joint space narrowing).

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References

  1. Anderson JM, Helm R (1982) Multiple joint osteonecrosis following short-term steroid therapy. J Bone Joint Surg Am 64:139–141

    Google Scholar 

  2. Arlet J, Ficat P (1968) Diagnostic de l’ostéo-nécrose fémoro-capitale primitive au stade I (stade pré-radiologique) Rev Chir Orthop 54:637–648

    CAS  Google Scholar 

  3. Bardin T, Fritz P (1992) Arthropathies destructrices de l’épaule. Ann Radiol 35:184–187

    PubMed  CAS  Google Scholar 

  4. Basset LW, Gold RH, Reicher M, Bennet LR, Tooke SM (1987) Magnetic resonance imaging in the early diagnosis of ischemic necrosis of the femoral head. Clin Orthop 214:237–248

    Google Scholar 

  5. Benoit J, Got C, Hardy P, Videcoq P (1989) L’ostéonécrose de la tête fémorale chez le transplanté rénal. Rev Chir Orthop 75:216–227

    PubMed  CAS  Google Scholar 

  6. Campion GV, MacCrae F, Alawan W, Wat I, Bradfield J, Dieppe P (1986) A Idiopathic destructive arthritis of the shoulder. J Bone Joint Surg Am 68:1913–1919

    Google Scholar 

  7. Cofield RH (1994) Osteonecrosis. In: Friedman RJ (ed) Arthroplasty of the shoulder. Thieme Medical, New York, pp 170

    Google Scholar 

  8. Constant CR, Murley AH (1987) A clinical method of functional assessment of the Shoulder. Clin Orthop 214:160–164

    PubMed  Google Scholar 

  9. Cruess RL (1986) Osteonecrosis of bone: current concepts as to etiology and pathogenesis. Clin Orthop 208:30–39

    PubMed  Google Scholar 

  10. Cruess RL (1985) Corticosteroid-induced osteonecrosis of the humeral head. Orthop Clin of North Am 4:789–796

    Google Scholar 

  11. Cruess RL (1976) Steroid-induced avascular necrosis of the head of the humerus. J Bone Joint Surg Br 58:313–317

    PubMed  CAS  Google Scholar 

  12. David HG, Bridgman SA, Davies SC, Hine AL, Emery RJ (1993) The shoulder in sickle cell disease. J Bone Joint Surg Br 75:538–545

    PubMed  CAS  Google Scholar 

  13. Dines DM, Warren RF, Pagnani MJ, Linsalata JC (1994) Osteonecrosis of the proximal humerus: natural history, long term natural history, long term follow-up and radiographic predictors of outcome. European Society for Surgery of the Soulder and the Elbow. 16–18 June, Barcelona

    Google Scholar 

  14. Fisher DE, Bickel WH (1971) Corticosteroid-induced avascular necrosis. A clinical study of 77 patients. J Bone Joint Surg Am 53:859–873

    PubMed  CAS  Google Scholar 

  15. Gazielly F, Thomas T, Bruyere G, Pasquier B, Grossetete JL (1995) Résultats de l’arthroplastie prothétique type Neer dans les traitements de lostéonécrose de la tête humérale. Rev Chir Orthop 81 [Suppl II]:99–103

    Google Scholar 

  16. Gerber C, Schneeberger AG, Vinh TS (1990) The arterial vascularization of the humeral head. J Bone Joint Surg 72A 72:1486–1494

    Google Scholar 

  17. Gregg PJ, Stothard J, Walder DN (1979) Regional distribution of circulating microspheres in the rabbit femur. J Bone Joint Surg Br 61:381

    Google Scholar 

  18. Hayes JM (1989) Arthroscopic treatment of steroid-induced osteonecrosis of the humeral head. Arthroscopy 5:218–221

    Article  PubMed  CAS  Google Scholar 

  19. Hernigou P (1995) Ostéonécrose des épiphyses de l’adulte. In: Encycl. Méd. Chir., Appareil locomoteur, 14028-A-10, Editions Techniques, Paris, p 12

    Google Scholar 

  20. Hopson CN, Siverhus SW (1988) Ischemic necrosis of the femoral head. J Bone Joint Surg Am 70:1048–1051

    PubMed  CAS  Google Scholar 

  21. Hungerford DS, Lennox DW (1985) The importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment. Orthop Clin North Am 16:635–654

    PubMed  CAS  Google Scholar 

  22. Laroche M, Arlet J, Mazières B (1990) Osteonecrosis of the femoral and humeral heads after intraarticular corticosteroid injections. J Rheumatol 17:549–551

    PubMed  CAS  Google Scholar 

  23. Lequesne M, Fallut M, Coulomb R, Magnet JL, Strauss J (1982) L’arthropathie destructrice rapide de l’épaule. Rev Rhumatisme 49:427–437

    CAS  Google Scholar 

  24. MacCarthy DJ, Halverson PB, Carrera GF, Brewer BJ, Kozin F (1981) Milwaukee shoulder: association of micro-spheroids containing hydroxyapatite crystals, active collagenase and neutral protease with rotator cuff defects. A clinical aspect. Arthritis Rheum 24:464–473

    Article  Google Scholar 

  25. Marcus ND, Enneking WF, Massam RA (1973) The silent hip in idiopathic aseptic necrosis. J Bone Joint Surg Am 55:1351

    PubMed  CAS  Google Scholar 

  26. Merle D’Aubigné R (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br 47:612–633

    PubMed  Google Scholar 

  27. Milner PF, Krauss AP, Sebes JI, Sleeper LA, Dukes KA, Emery SH, Bellevue R, Koshy M, Moohr JW, Smith J (1993) Osteonecrosis of the humeral head in sickle cell disease. Clin Orthop 289:136–143

    PubMed  Google Scholar 

  28. Neer CS, Craig EV, Fukuda H (1983) Cuff tear arthropathy. J Bone Joint Surg Am 65:1232–1244

    PubMed  Google Scholar 

  29. Neer CS (1990) Shoulder reconstruction. Saunders, Philadelphia

    Google Scholar 

  30. O’Brien PH, Mack GR (1992) Multifocal osteonecrosis after short-term. High-dose corticosteroid therapy. Clin Orthop 279:176–179

    PubMed  Google Scholar 

  31. Rosenberg F, Kahn MF, Bensasson M, Dorfmann H, de Seze S (1972) L’ostéonécrose aseptique de la tête humérale. Rev Rhum 39:407–416

    PubMed  CAS  Google Scholar 

  32. Ruffle R, Fournie A, Ayrolles C, Cuq P (1962) Résultats de la phlébographie pertrochanterienne dans les ostéonécroses primitives de la tête fémorale chez l’adulte. Rev Rhum 29:551

    Google Scholar 

  33. Rutherford CS, Cofield RJ (1987) Osteonecrosis of the shoulder. Orthop Trans 11:239

    Google Scholar 

  34. Saito S, Inoue A, Ono K (1987) Intramedullary haemorrhage as a possible cause of avascular necrosis of the femoral head. J Bone Joint Surg Br 69:346–351

    PubMed  CAS  Google Scholar 

  35. Seze de S, Hubault A, Rampon S (1967) L’épaule sénile hémorragique. In: L’Actualité Rhumatologique. Expansion Scientifique (eds), Paris, p 107

    Google Scholar 

  36. Taylor LJ (1984) Multifocal avascular necrosis after short-term high-dose steroid therapy. A report of three cases. J Bone Joint Surg Br 66:431–433

    PubMed  CAS  Google Scholar 

  37. Urquhart MW, Mont MA, Maar DC, Lennox DW, Krackow KA, Hungerford DS (1992) Results of core decompression for avascular necrosis of the humeral head. Orthop Trans 16:780

    Google Scholar 

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Authors
  1. L. Nové-Josserand
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  2. M. Basso
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Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Lyon, 116, Rue Antoine Charial, 69003, Lyon, France

    Gilles Walch M.D.

  2. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Nice, 151, Route de Saint-Antoine de Ginestière, 06200, Nice, France

    Pascal Boileau M.D.

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© 1999 Springer-Verlag Berlin Heidelberg

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Nové-Josserand, L., Basso, M. (1999). Atraumatic Avascular Necrosis of the Humeral Head: Clinical and Radiographic Classification. In: Walch, G., Boileau, P. (eds) Shoulder Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58365-0_26

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  • DOI: https://doi.org/10.1007/978-3-642-58365-0_26

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63554-0

  • Online ISBN: 978-3-642-58365-0

  • eBook Packages: Springer Book Archive

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