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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

 

 

 

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