Steroid-induced osteonecrosis of the humeral head in a 20-year-old man treated with an osteochondral autograft: A case report

• Published in: Modern rheumatology case reports Vol. 7; no. 1; pp. 247 - 251
• Main Authors: Hotta, Tadahiro, Kozono, Naoya, Takeuchi, Naohide, Nabeshima, Akira, Kawahara, Shinya, Hamai, Satoshi, Akasaki, Yukio, Tsushima, Hidetoshi, Tashiro, Eiji, Konishi, Toshiki, Nakashima, Yasuharu
• Format: Journal Article
• Language: English
• Published: England 03.01.2023
• Subjects: Adrenal Cortex Hormones; Adult; Autografts; Humans; Humeral Head - transplantation; Male; Middle Aged; Osteonecrosis - chemically induced; Osteonecrosis - diagnosis; Steroids; Young Adult; young adulthood; shoulder joint; osteochondral autograft; osteonecrosis of the humeral head
• ISSN: 2472-5625; 2472-5625
• DOI: 10.1093/mrcr/rxac037

To our knowledge, only one previous report described the treatment of osteochondral autograft for steroid-induced osteonecrosis of the humeral head (ONHH) in a middle-aged patient. The present report describes a 20-year-old man who was found to have avascular osteonecrosis of the right humeral head after corticosteroid pulse treatment, followed by oral corticosteroid therapy. The patient complained of serious right shoulder pain and limited range of motion (ROM). Anteroposterior (AP) radiographs of the right shoulder revealed a crescent sign at the humeral head, indicating subchondral bone collapse with a linear sclerotic change and normal articular surface of the glenoid. The case was categorized as Stage 3 according to the Cruess classification. In general, Cruess classification Stage 3 is treated with humeral head replacement and shoulder arthroplasty. The patient underwent surgical treatment involving osteochondral autograft transplantation. Autografts were harvested from the right knee. At the 1.5-year follow-up, the patient was pain-free and showed an improved active ROM. Furthermore, AP radiographs demonstrated that the glenohumeral joint space was maintained, and no progression of humeral head collapse was observed. This case may be helpful in decision-making if young patients with ONHH require surgical treatment. Furthermore, osteochondral autograft transplantation may be an effective treatment for ONHH.