STEROID-INDUCED AVASCULAR NECROSIS OF THE HEAD OF THE HUMERUS

Abstract

Ninety-five patients with steroid-induced avascular necrosis of bone have been personally treated by the author. Of these, eighteen had a lesion of the head of the humerus, on one or both sides. The conditions for which the steroids were given included post..transplantation, lupus erythematosus, glomerulonephritis and asthma. The characteristic lesion began as a subchondral osteolytic area which frequently progressed to collapse. The articular cartilage divided from the subchondral bone, either becoming detached as a free cap or at a later stage reattaching. In some cases the lesion was minimal and the symptoms were slight. Conservative freatment has consisted of pendulum exercises and avoidance of abduction, particularly against resistance. In fourteen patients this led to satisfactory function with only intermittent symptoms. Four patients required replacement of five humeral heads with Neer’s prostheses. After one to seven years the results of all five were classified as excellent in terms of absence of symptoms and a free range of movement. Cortisone has proved to be an extremely useful drug capable of profoundly affecting the course of many diseases. However, in terms ofcomplications and side effects the price which the patient must pay has at times been high, and the medical profession has been faced with the problem of avascular necrosis of bone. So far there has been no report in the literature of the natural history and management of steroid-induced avascular necrosis of the head of the humerus. This paper outlines the author’s experience of eighteen cases.