Percutaneous Balloon Cementoplasty for Treatment of Bilateral Osteonecrosis of the Humeral Head

Abstract

Osteonecrosis of the humeral head occurs at a rate lower than in the hip, however, it can result in considerable morbidity. Left untreated, most cases result in subchondral collapse and eventual arthrosis of the glenohumeral joint [1]. Risk factors associated with osteonecrosis include alcohol abuse, corticosteroid use, chemotherapy and other less common processes [2]. The treatment for pre collapse osteonecrosis includes pharmacologics, core decompression, and bone grafting [3]. Hemiarthroplasty and total shoulder arthroplasty are reserved for Ficat stage IV and V disease respectively [4]. Percutaneous cementoplasty has been used for a variety of conditions including vertebral compression fractures, painful bone metastases, and avascular necrosis [5]. Recent data from a randomized controlled trial of kyphoplasty versus medical management have shown that this procedure outperforms medical management in regards to pain relief and patient mobilization [6]. Cementoplasty performed for osteonecrosis of the femoral head has been shown to temporarily relieve pain and improve function, however, it did not prevent eventual total hip arthroplasty in one retrospective study [7]. We present a unique case in which a patient with severe pain due to bilateral osteonecrosis of the humeral heads, and a limited lifespan secondary to metastatic breast carcinoma, was treated with percutaneous balloon cementoplasty of the humeral heads. To our knowledge this treatment has not been reported in the literature. The patient gave informed consent to use this case in a case report, and understood that no identifying information would be used.