Technique and Early Results of Intramedullary Pressure-Guided Core Decompression of the Humeral Head for Nontraumatic Osteonecrosis

Abstract

The purpose of this study was to describe a modified technique for humeral head core decompression using biplanar fluoroscopy and intraosseous pressure monitoring to identify osteonecrotic regions for targeted decompression. A bone marrow biopsy needle and arterial pressure monitoring equipment were used to locate the region of maximum pressure, and then acorn-style reamers decompressed the osteonecrotic bone. In 12 shoulders (11 patients) evaluated, the peak intramedullary lesion pressure was, on average, 6 times higher than the entry pressure. At 6 months, Visual Analog Scale pain scores had decreased in all shoulders by 70.3% (P < 0.0001) on average. Nine of 12 shoulders, with an average follow-up of 44.2 months (range, 12-72.5 months), were evaluated for pain relief, disease progression, and need for arthroplasty. In that group, Visual Analog Scale pain scores had decreased by 56.8% (P < 0.008) on average. Only 1 patient, despite excellent initial results, had progression of symptoms and required arthroplasty at 12 months. Pressure-guided core decompression provides a technique for directly localizing the osteonecrotic bone and potentially improving decompression outcomes.