The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease—a cohort review

Abstract

Purpose: A formalised, universally accepted, radiological staging system of gleno-humeral joint osteonecrosis (ON) is lacking. Consequently, there is absence of a standardised management strategy. The aim is to propose a simple radiological staging system of gleno-humeral joint ON based on principles of the Association Research Circulation Osseous (ARCO) Society and review of clinical practice. Methods: A radiographic and clinical review of 45 patients with haematological-induced gleno-humeral ON was performed. The related management plans were analysed and categorised. Results: Analysis divided the disease into stages 0–4. Non-interventional management was the first-line treatment in stages 1–2. If unsuccessful, arthroscopic core decompression was performed. Patients with stages 3–4 were initially managed conservatively. If unsuccessful, in younger patients, arthroscopic joint debridement and capsular release was trialled. In older patients, or where this approach failed, shoulder arthroplasty was advised. Conclusion: The simple radiological classification assessed is useful to the provision of a standardised staged management strategy of gleno-humeral ON.