You are here

Core Decompression Humeral head 23929

avascular necrosis humerus xray 

avascular necrosis humerus xray

avascular necrosis humerus mri

x-ream pro-stim

CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms: core decompression,

Core Decompression Humeral Head CPT

Core Decompression Humeral Head Indications

  • Humeral head osteonecrosis (avascular necrosis) stage I and II

 Core Decompression Humeral Head Contraindications

  •  Humeral head osteonecrosis Stage III, IV, V

Core Decompression Humeral Head Alternatives

  • Conservative care (PT, activity modification, NSAIDs)
  • Humeral head resurfacing
  • Humeral hemiarthroplasty
  • Total Shoulder replacement

Core Decompression Humeral Head Pre-op Planning

  • Consider Wright Medical core decompression kit and graft

Core Decompression Humeral Head Technique

  • 2cm stab incision for access. Under fluoroscopic guidance (both AP & Lat. views), introduce the 3.2mm fluted guide-wire into central aspect of lesion. 
  • Place tissue protector over the guide-wire down to bone.
  • Using 9mm cannulated drill bit, decompress the femoral head
  • Place working cannula with obturator through the tissue protector and into the core. 
  • Remove the tissue protector and obturator.
  • Place X-REAM™ Percutaneous Expandable Reamer. Cofirm placement with fluoro (AP & Lat. views).  Turn the blade control knob ¼ turn (or less) clockwise and rotate the entire instrument at least one full revolution.  Repeat until desired expansion is achieved.  Frequently confirm blade position under fluoro (BOTH A/P and LAT views).
  • Removed X-Ream device.  Irrigate and suction.
  • Backfill the core with bone graft or Injectable Graft.
  • Close in standard fashion.

Core Decompression Humeral Head Complications

Core Decompression Humeral Head Follow-up care

  • Post-op: sling, pendelum ROM exercises
  • 7-10 Days: Follow up for wound check and start PT
  • 6 Weeks: Xrays, assess ROM, gradually resume normal activities. 
  • 3 Months: Xrays, progress with activities as tolderated. 
  • 6 Months: Xrays, evaluate function and ROM. 
  • 1Yr: Xrays. 

Core Decompression Humeral Head Outcomes

  • Average 5.6 year follow up. 73% good or excellent clinical results; 27% required arthroplasty. All with stage I or II radiological changes (Ficat and Arlet 1980) at operation had good or excellent results. (Mont MA, JBJS 1993;75BR; 785)
  • 88% of sickle cell or steroid induced patients demonstrated progression of disease after core decompression (Kennon JC, JSES 2016 Sep;25(9):1442-8).
  • Stage I disease 94% successful outcomes,  Stage II 88%, Stage III 70%,  Stage IV 14% (LaPorte DM, CORR 1998 Oct;355:254-60). 

Core Decompression Humeral Head Review References





The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer