Single-Stage Bilateral Stemless Shoulder Hemiarthroplasty using a Subscapularis-Sparing Approach for Bilateral Dysbaric Osteonecrosis of the Humeral Head in a Diver: A Case Report.

Abstract

Introduction:Dysbaric osteonecrosis (DON) is a specific type of atraumatic osteonecrosis that has been shown to occur mainly in deep-sea divers and workers exposed to increased air pressure environments. The pathophysiology is not entirely understood but is thought to be due to subclinical decompression sickness resulting in arterial gas emboli. This leads to vascular occlusion and subsequent bone death.Case Report:An active 56-year-old male diver presented with progressive bilateral shoulder pain and dysfunction due to bilateral DON of the humeral head and associated posterosuperior rotator cuff tearing. The diagnosis was confirmed by physical examination, X-rays, and magnetic resonance imaging. Due to failure of conservative treatment, a single-stage bilateral, subscapularis-sparing, stemless shoulder hemiarthroplasty with concomitant rotator cuff repair was performed. At 24-month follow-up, the patient showed satisfactory functional outcomes in both shoulders without complication.Conclusion:This single-stage surgical treatment is an exceptional indication for a bilateral dysbaric humeral head osteonecrosis that can be considered in selected cases because may reduce the total recovery time and can be safe and effective at 24 months postoperatively.