Osteonecrosis of the Humerus: Trends in Surgical Management of a Nationwide Sample From 2010 to 2021.

Introduction: The humeral head is the second most common site for osteonecrosis but its epidemiology is poorly described. This study aimed to better understand its treatment in the United States by 1) evaluating total operative procedures with rates normalized to the annual surgical volume; 2) determining trends of non-joint preserving (shoulder arthroplasty) vs. joint preserving procedures; and 3) quantifying rates of operative techniques in different aged cohorts (<50 vs. ≥50 years old).

Methods: A nationwide database was queried for patients with humeral osteonecrosis who underwent surgery between January 1st, 2010 and April 30, 2021, yielding 9,307 cases. Patients classified under non-joint preserving procedures included those who underwent shoulder arthroplasty (total and reverse) (N = 5,752) and hemiarthroplasty (N = 2,086). Joint preserving procedures included humeral head core decompression and arthroscopic débridement (N = 1,469). The percentage of patients annually managed by each operative procedure was calculated and normalized to the overall annual surgical population from our sample. Linear regression modelling was performed to evaluate trends/differences in procedural volume over time based on the type of procedure (joint preserving vs. non-preserving) and age cohort (under versus over 50 years old). P-values < 0.05 were significant.

Results: Within this nationwide sample, the number of procedures to treat shoulder osteonecrosis relative to all shoulder procedures was 0.85% (9,307/1,092,726). Overall, shoulder arthroplasty (total and reverse) was the most commonly performed procedure (N = 5,752; 61.8%), followed by hemiarthroplasty (N = 2,086; 22.4%), and core decompression/arthroscopic débridement (N = 1,469; 15.8%). Non-joint preserving comprised 7,838 procedures (84.2%), while 1,469 (15.8%) were joint preserving. On age group subanalysis, there were significantly more joint preserving procedures in patients aged <50 years (25.8% vs. 14.1%, P < 0.001). Core decompression/arthroscopic débridement as a proportion of all procedures in patients younger than 50 increased over the study period (22.1% to 35.6%, P = 0.035).

Conclusion: Procedures used to manage humeral osteonecrosis comprise less than 1% of all shoulder surgeries. These procedures continue to be predominantly shoulder arthroplasty; however, the utilization of joint preserving procedures seem to be growing over time, notably in patients <50 years of age. Shoulder surgeons may use this data to better educate patients about treatment options during the decision-making process. Future studies should be aimed towards further characterizing patterns in the diagnosis and treatment of humeral osteonecrosis.