Avascular Necrosis/Core Decompression
What is Core Decompression for Avascular Necrosis?
The shoulder is a highly mobile ball and socket joint. The ball of the upper arm bone (humerus) is held in place at the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments.
Sickle cell disease, a group of disorders that affect the hemoglobin or oxygen carrying component of blood, causes avascular necrosis or the death of bone tissue due to lack of blood supply.
The condition causes pain due to increased pressure in the blood vessels of the bone marrow at the region of the necrosis.
Early stages of avascular necrosis can be treated by core decompression surgery, which reduces pressure, promotes blood flow and encourages healing of the bone. Dr. Patel routinely injects the area with bone marrow aspirate which has stem cells and has been shown to improve healing rates in AVN.
Indications for Core Decompression
Core decompression is indicated in the early stages of avascular necrosis, when the surface of the joint is still smooth and round. It is done to prevent total shoulder replacement surgery, which is indicated for severe cases of avascular necrosis and involves the replacement of the shoulder joint with an artificial device or prosthesis.
Surgical Procedure of Core Decompression for Avascular Necrosis
Core decompression is done under spinal or general anesthesia. The patient is placed on his/her back in a supine position. Live X-ray imaging or fluoroscopy is used to guide Dr. Patel during the procedure.
A small incision is made on your shoulder and a guide wire is passed from the incision to the necrotic area. A hole is then drilled along the wire. The necrotic bone is then removed. This reduces the pressure immediately and creates space for the new blood vessels to grow and nourish the existing bone.
The cavity that is left behind in the bone is sometimes filled with bone graft taken either from another part of your body or a cadaver. Sometimes, synthetic bone graft material is used. The incision is then closed with sutures. Another variation of the same surgery involves drilling very small diameter holes from a single point. The surgical wound in this case is very small and may require only a single suture.
Postoperative Care Following Core Decompression for Avascular Necrosis
You will be able to resume your regular activities 3 months after the surgery.
Advantages of Core Decompression for Avascular Necrosis
The advantages of core decompression include the following:
- Prevents complications
- Preserves bone
- Delays the need for total shoulder replacement where the diseased humeral head is replaced with an artificial prosthesis
Risks and Complications of Core Decompression for Avascular Necrosis
As with all surgeries, core decompression may be associated with certain complications such as:
- Fracture along the core track
- Perforations in the humeral head
- Deep vein thrombosis
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