Management of Bilateral Humeral Head Avascular Necrosis in Sickle Cell Disease Using Surgical Intervention With...

BACKGROUND Avascular necrosis (AVN) is a disabling musculoskeletal complication of sickle cell disease (SCD), resulting from recurrent vaso-occlusive episodes and chronic microvascular ischemia. Although weight-bearing joints such as the femoral head are most commonly affected, humeral head involvement can lead to significant pain and functional limitation. Management of AVN in SCD remains challenging, and interest has grown in adjunctive therapies such as hyperbaric oxygen therapy (HBOT), which can enhance tissue oxygenation, promote angiogenesis, and support bone remodeling. Evidence regarding its role in non-weight-bearing joints remains limited. CASE REPORT A 32-year-old woman with homozygous SCD (HbSS) presented with a 2-month history of progressive bilateral shoulder pain and restricted motion. Magnetic resonance imaging (MRI) demonstrated stage II pre-collapse AVN of both humeral heads. Baseline laboratory evaluation showed stable chronic anemia consistent with SCD, without evidence of acute infection or inflammatory elevation. Following perioperative exchange transfusion to reduce hemoglobin S concentration, she underwent arthroscopic-assisted core decompression with ipsilateral fibular strut autografting of both shoulders in staged procedures. Postoperatively, she completed 40 sessions of HBOT at 2.5 atmospheres absolute for 60 min each, in addition to oral alendronate 70 mg weekly for 6 months. During clinical follow-up, she reported complete resolution of pain and restoration of full, pain-free range of motion bilaterally. Post-treatment MRI demonstrated preserved articular architecture with improvement in marrow signal. CONCLUSIONS This case report shows that a multimodal joint-preserving approach combining surgical decompression and adjunctive HBOT can be associated with meaningful clinical improvement in early-stage humeral head AVN secondary to SCD. However, as multiple concurrent interventions were employed, the independent contribution of HBOT cannot be determined. Larger studies are required to clarify its adjunctive role.