From the Guidelines
Osteonecrosis of the humeral head is a condition that can lead to subchondral fracture and secondary osteoarthritis, and its management should prioritize preventing articular collapse and delaying or preventing the need for joint replacement. The typical management of osteonecrosis of the humeral head includes noninvasive therapies such as statins, bisphosphonates, anticoagulants, extracorporeal shock wave therapy, and hyperbaric oxygen, although the evidence supporting these treatments is limited 1. Invasive therapies, such as core decompression, can be performed to prevent articular collapse, but their efficacy is controversial 1. The necrotic volume of the humeral head, measured via the necrotic angle, can predict the risk of collapse, with a necrotic angle <90 associated with a lower risk of collapse 1.
Some key points to consider in the management of osteonecrosis of the humeral head include:
- Early diagnosis is crucial to exclude other causes of pain and to allow for possible early surgical prevention 1
- Imaging is important for preoperative planning and to assess the extent of the necrotic lesion 1
- The Ficat and Arlet staging system is commonly used to classify osteonecrosis, but other systems such as the University of Pennsylvania (Steinberg), Association Research Circulation Osseous (ARCO), and Japanese Orthopedic Association systems may also be used 1
- Noninvasive therapies may be considered, but their efficacy is limited, and invasive therapies such as core decompression may be necessary to prevent articular collapse 1
It is essential to weigh the potential risks and benefits of each treatment option and to consider the individual patient's circumstances, including their age, medical comorbidities, and functional status 1. The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) documents to guide the management of various orthopedic conditions, including osteonecrosis, and these documents can provide valuable guidance for clinicians 1. However, the management of osteonecrosis of the humeral head remains controversial, and the scientific evidence on this topic can be significantly improved 1.
From the Research
Humera
- There are no research papers to assist in answering this question as the provided studies do not mention "Humera" in their text.
- The studies provided discuss the use of adalimumab, etanercept, golimumab, and infliximab in treating rheumatic pathologies such as rheumatoid arthritis (RA), psoriatic arthritis (PSA), and ankylosing spondylitis (AS) 2, 3, 4, 5, 6.
- These studies evaluate the efficacy, safety, and cost-effectiveness of these treatments, but do not provide information on "Humera".
- Further research or clarification on the term "Humera" would be necessary to provide a more accurate response.