Krishnan, J Bone Joint Surg Am 2007 - Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis. Two to Fifteen-Year Outcomes

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Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis. Two to Fifteen-Year Outcomes

Krishnan, Burkhead, et al.·J Bone Joint Surg Am·2007·129 citations·Prospective cohort

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Background

Biologic glenoid resurfacing was developed in 1988 as an alternative to total shoulder arthroplasty in selected (usually younger) patients with primary, posttraumatic, or postreconstructive glenohumeral arthritis. A variety of biologic surfaces, including anterior capsule, autogenous fascia lata, and Achilles tendon allograft, have been combined with a humeral hemiarthroplasty.

Methods

From November 1988 to November 2003, 34 patients (36 shoulders) who were managed with biologic glenoid resurfacing and humeral head replacement either with cement (10 shoulders) or without cement (26 shoulders) were followed prospectively.
The study group included 30 men and 4 women with an average age of 51 years.
The diagnoses included primary glenohumeral osteoarthritis (18 shoulders), postreconstructive arthritis (12), posttraumatic arthritis (5), and osteonecrosis (one).
Anterior capsule was used for 7 shoulders, autogenous fascia lata for 11, and Achilles tendon allograft for 18.
All shoulders were assessed clinically and with serial radiographs.

Results

The mean American Shoulder and Elbow Surgeons score was 39 points preoperatively and 91 points at the time of the most recent follow-up.
According to Neer's criteria, the result was excellent for 18 shoulders, satisfactory for 13, and unsatisfactory for 5.
Glenoid erosion averaged 7.2 mm and appeared to stabilize at 5 years.
There were no revisions for humeral component loosening.
Complications included infection (2 patients), instability (3 patients), brachial plexitis (one patient), and deep-vein thrombosis (one patient).
Factors that appeared to be associated with unsatisfactory results were the use of capsular tissue as the resurfacing material and infection.

Conclusions

Biologic resurfacing of the glenoid can provide pain relief similar to total shoulder arthroplasty. It allows selected younger patients to maintain an active lifestyle, including weight-lifting and manual work, without the risk of polyethylene wear. On the basis of this and previous reviews, we currently recommend Achilles tendon allograft as the preferred resurfacing material when this option is chosen.

Level of evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright remains with the authors and publisher.

Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis. Two to Fifteen-Year Outcomes.

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Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis. Two to Fifteen-Year Outcomes

Krishnan, Burkhead, et al.·J Bone Joint Surg Am·2007·129 citations·Prospective cohort

|

Background

Biologic glenoid resurfacing was developed in 1988 as an alternative to total shoulder arthroplasty in selected (usually younger) patients with primary, posttraumatic, or postreconstructive glenohumeral arthritis. A variety of biologic surfaces, including anterior capsule, autogenous fascia lata, and Achilles tendon allograft, have been combined with a humeral hemiarthroplasty.

Methods

From November 1988 to November 2003, 34 patients (36 shoulders) who were managed with biologic glenoid resurfacing and humeral head replacement either with cement (10 shoulders) or without cement (26 shoulders) were followed prospectively.
The study group included 30 men and 4 women with an average age of 51 years.
The diagnoses included primary glenohumeral osteoarthritis (18 shoulders), postreconstructive arthritis (12), posttraumatic arthritis (5), and osteonecrosis (one).
Anterior capsule was used for 7 shoulders, autogenous fascia lata for 11, and Achilles tendon allograft for 18.
All shoulders were assessed clinically and with serial radiographs.

Results

The mean American Shoulder and Elbow Surgeons score was 39 points preoperatively and 91 points at the time of the most recent follow-up.
According to Neer's criteria, the result was excellent for 18 shoulders, satisfactory for 13, and unsatisfactory for 5.
Glenoid erosion averaged 7.2 mm and appeared to stabilize at 5 years.
There were no revisions for humeral component loosening.
Complications included infection (2 patients), instability (3 patients), brachial plexitis (one patient), and deep-vein thrombosis (one patient).
Factors that appeared to be associated with unsatisfactory results were the use of capsular tissue as the resurfacing material and infection.

Conclusions

Biologic resurfacing of the glenoid can provide pain relief similar to total shoulder arthroplasty. It allows selected younger patients to maintain an active lifestyle, including weight-lifting and manual work, without the risk of polyethylene wear. On the basis of this and previous reviews, we currently recommend Achilles tendon allograft as the preferred resurfacing material when this option is chosen.

Level of evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright remains with the authors and publisher.

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