Table 1.
Clinical outcome studies for core decompression of the humeral head
| Study | Study type | No. of patients (shoulders) | Age (range, yr)/sex | Follow-up (range) | Procedure | Graft | Disease stage | Outcome | Complication/ advancement of disease |
|---|---|---|---|---|---|---|---|---|---|
| Mont et al. (1993)a) [13] | Retrospective review | 20 (30) | 38 (22–76)/5.6 yr | 11 F, 9 M | 5-mm diameter coring device (single large trephine) | No graft | Six shoulders had stage I changes, | UCLA shoulder rating systemc): 20 excellent, 2 good, 8 poor requiring hemi or TSA; all shoulders with initial stage I or II (n=14) had good or excellent; at time of follow-up, 11/14 stage I or II deteriorated radiologically; of 10 stage III—7 with excellent, 3 with arthroplasty; of stage IV, 1 with good and 5 requiring arthroplasty | 5/6 Stage IV progressed to TSA |
| 8 stage II, 10 stage III, and 6 stage IVb) | |||||||||
| L'Insalata et al. (1996) [5] | Retrospective review | 4 (5) | Not indicated | Range, 1 mo–4 yr | Humeral head drilling | No graft | Stage IIIb) | Not indicated | 4/5 Progressed to arthroplasty at intervals of 1 month, 1 year, 1 year, and 3 years; fifth shoulder with progression to stage IV |
| LaPorte et al. (1998)a),d)[12] | Retrospective review | 43 (63) | CSI group: 37 (22–60)/ 20 F 14 M; Non-CSI group: 41 (23-78)/ 4 F 5 M | 10 yr (2–20) | Single large trephine, percutaneous fluoroscopic guided core decompression | No graft | CSI groupb): stage I, 14; stage II, 13; stage III, 18; stage IV, 5 Non-CSI group: stage I, 2; stage II, 4; stage III, 5; stage IV, 2 | Average preoperative and postoperative UCLA shoulder scoresc) based on stage; stage 1, 17–27; stage 2, 15–27; stage 3, 14–25; stage 4, 12–20 | 16 Shoulders (1 stage I, 2 stage II, 7 stage III, 6 stage IV) required shoulder arthroplasty |
| Mont et al. (2000)a) [36] | Retrospective review | 95 Shoulders | Total project: 41 yr (20-60)/ 47 F 26 M; Core decompression specific not listed | 6 yr (2–21) | 5-mm diameter coring device (single large trephine) | No graft | Stage I, 16; stage II, 37; stage III, 34; stage IV, 8b) | UCLA shoulder rating systemc): stage I, 15/16 successful clinical outcomes; stage II, 34/37 successful; stage III, 24/34 successful; 9 shoulders improved to stage II; stage iV, 1/8 successful | No complications from core decompression; 8 stage II progressed to stage III; 12 stage III progressed to stage IV |
| Harreld et al. (2009) [11] | Retrospective review | 15 (26) | 37 (15–50)/7 F, 8 M | 32 mo (24-41) | Percutaneous small-diameter perforations technique under fluoroscopy guidance | No graft | Stage I/IIe) (as modified by Cruess) | UCLA shoulder rating systemc): mean score: preoperative, 14 (10–22) and postoperative, 27 (14–30) | 1 Patient with spondyloarthropathy had poor outcome (11→14 postop) although with multijoint involvement |
| Kennon et al. (2016) [10] | Case series | 11 (11) | Total in study: 37.3±15.3/15 F, 5 M | 8/11 1-yr FU; 2/3 of those lost had persistent shoulder pain | Core decompression with ultrasound bone stimulation | No graft | Stage I/IIe) | 6/6 of SCD and 1/2 of CSI progressed to further collapse (mean time of 17.4 months); functional scores only assessed following resurfacing, TSA, or RTSA | 5 Required further resurfacing procedures due to continued symptoms at mean of 12.9 months |
| Dines et al. (2007) [46] | Case report | 3 (3) | 37, 49, 36/3 F | Patient 1: 7 mo; patient 2: 9 mo; patient 3: 11 mo | Arthroscopic-assisted core decompression with ACL tibial drill guide | No graft | Stage II | Final FU: patient 1, FF 165°; Ext rot, 85°; IR T12, no pain medication for shoulder; patient 2, IR T12 final follow-up; patient 3, no pain medication at final follow-up, range of motion was same as prior to surgery | Patient 2: persistent pain at 9 month FU, resolved with injection of Decadron and xylocaine |
| Steffensmeier et al. (2016) [47] | Case report | 1 (2) | 51/F | 8 mo (shoulder 1); 4 mo (shoulder 2) | Arthroscopic-assisted core decompression | Synthetic bone grafting (Pro-Dense, Wright Medical) | Extensive subchondral osteonecrosis without joint collapse - bilateral; staging not indicated | Asymptomatic with full range of motion (shoulder 1); mild residual stiffness (shoulder 2) | None |
| Makihara et al. (2017) [48] | Case report | 4 (5) | 48 (38–63)/ 3 F, 1 M | 49.4 mo (24–73) | Percutaneous fluoroscopic guided core decompression | Autologous concentrated bone marrow | Stage III, 4; stage IV, 1e) | Stage III: average change of VAS from 33 mm preoperative to 5 mm postoperative; stage IV: failed joint sparing requiring TSA at 20 months post-index procedure | Stage IV shoulder requiring TSA at 20 months post-index procedure |
| Hernigou et al. (2020) [23] | Retrospective review | 30 (30) Mesenchymal cell treated; 34 (34) matched pair control group | 46.5 (28–60)/24 F, 37 M | 7 yr (5–10) | Percutaneous Core decompression | Mesenchymal cell injection (30/64 patients); untreated simple core-decompression (34/64) | Mesenchymal cell treatede): stage I, 8; stage II, 10; stage III, 7; stage IV, 5 | Average improvements in constant scores of 40 (35–56) to 71 (50–88) in cell therapy group and 43 (31–60) to 57 (43–70) in untreated (P=0.01); average improvement in VAS scores of 45.8±7.2 to 16±3.2 in cell therapy group and 43.2±8.5 to 29±4.1 in untreated group (P=0.01) | 3/30 Mesenchymal treated progressed to collapse vs. 25/34 in untreated group (P<0.0001); 2/30 mesenchymal treated progressed to arthroplasty vs. 25 in untreated group |
| Galloway et al. (2013) [49] | Retrospective review | 14 (17) | Precollapse: 44 (33–61); postcollapse 30 (19–40) | postcollapse: 7 yr (3–18); postcollapse: 2.4 yr (1.5–3) | Arthroscopic-assisted core decompression | Fibular strut Allograft | 8 Precollapsee) (stage I and stage II); 6 postcollapse (2 stage III and 4 stage IV) | Precollapse SPADI scoresf): 1 poor, 4 good, 2 excellent; postcollapse SPADI scores: one poor, 3 excellent, 4 missing outcome scores | 2 Stage II and 1 stage IV progressed to hemiarthroplasty |
UCLA: University of California Los Angeles, TSA: total shoulder arthroplasty, CSI: corticosteroid injection, FU: follow-up, SCD: sickle cell disease, RTSA: reverse total shoulder arthroplasty, FF: forward Flexion, Ext: external rotation, IR: internal rotation, VAS: visual analog scale, SPADI: Shoulder Disability and Shoulder Pain and Disability Index.
a)
Contain same patient population;
b)
Staging based upon Ficat and Arlet classification;
c)
UCLA shoulder rating system. Ten points assigned for each of three categories; pain, function and active movement with max of 30; excellent 27 or more, good is 24–26, fair 21–23, poor <21;
d)
20 (30) from Mont et al. (1993) [13
e)
Staging based upon Cruess classification;
f)
SPADI; scores 0–25 deemed excellent; 26–50 are good; 51–75 are fair; 76–100 are poor.