Osteonecrosis of the humeral head is considerably less common than osteonecrosis of the hip. However, as in the hip, the interaction between a genetic predisposition and certain risk factors may lead to increased intraosseous pressure, loss of circulation, and eventual bone death. The most common risk factor remains corticosteroid use, which accounts for most reported cases. Radiographic staging and measurement of lesion size are predictive of disease progression and can be used to determine appropriate intervention. Recent studies have reported the use of various treatment modalities such as pharmacologics, core decompression with small-diameter drilling, arthroscopic-assisted core decompression, and bone grafting. Prospective, randomized studies are needed to determine the efficacy of these joint-preserving procedures. Newer resurfacing techniques have a role in treating articular surface loss. Hemiarthroplasty and total shoulder arthroplasty are recommended for patients with end-stage disease.
* Dr. Harreld and Mr. Marker contributed equally as first author on this manuscript.
Dr. Harreld is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC. Mr. Marker is Research Assistant, Sinai Hospital of Baltimore, Baltimore, MD, and Medical Student, Johns Hopkins School of Medicine, Baltimore. Dr. Wiesler is Associate Professor, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center. Dr. Shafiq is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Howard University Hospital, Washington, DC. Dr. Mont is Director, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore.
Reprint requests: Dr. Mont, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215.
Dr. Mont or a member of his immediate family has received royalties from Stryker; serves as a paid consultant to or is an employee of Stryker and Wright Medical Technology; and has received research or institutional support from Stryker, Wright Medical Technology, Biomet, Brainlab, DePuy, Finsbury, Smith & Nephew, and Salient Surgical Technologies. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Harreld, Mr. Marker, Dr. Wiesler, and Dr. Shafiq.