Wednesday, September 9, 2020

Avascular necrosis in a patient under 40 years of age

 A young man present with incapacitating pain in his left shoulder.

His plan films and MRI show a small central area of avascular necrosis. No risk factors for AVN were identified.

After discussion of the alternatives of non-operative management, debridement, drilling the defect, a partial prosthetic surface replacement, an allograft and a hemiarthroplasty, the patient elected the latter.

At surgery the glenoid articular cartilage was intact. A central defect in the humeral head was seen
with a loose flap of cartilage
An anatomic hemiarthroplasty was performed under general anesthesia without a brachial plexus block using a canal-sparing smooth stemmed humeral component inserted with impaction autografting.

On the evening of surgery he had excellent comfortable range of motion.

Comment: While other options were considered, a robust anatomic hemiarthroplasty was selected to provide a durable return to high levels of activity.

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