This is a Level IV case series of 45 young patients (mean age 42) treated for glenohumeral arthritis with hemiarthroplasty plus biologic glenoid resurfacing. Resurfacing used either a lateral meniscal allograft or human acellular dermal tissue matrix. It asks whether the good short-term outcomes hold up at intermediate follow-up.
The young active patient with glenohumeral arthritis is one of the hardest problems in shoulder surgery, and this paper explains why biologic resurfacing has largely fallen out of favor.
The attractive concept was to interpose soft tissue over the glenoid to relieve pain while delaying the day you commit to a glenoid prosthesis. This series shows the concept does not hold up: over half fail by 2.8 years, and the joint space narrows radiographically as the graft degrades.
A useful mental model is that a soft tissue patch cannot survive the compressive and shear loads of an active shoulder, so the underlying bipolar disease keeps progressing.
Note the trap in the outcome scores. Mean ASES, VAS, and SST all improved significantly from baseline, yet the same cohort had a greater than 50% clinical failure rate. Statistically significant improvement from a miserable baseline is not the same as a good result.
Contrast this with the more durable competitors: hemiarthroplasty survival is roughly 92% at 5 years, and total shoulder arthroplasty gives reliable pain relief when the glenoid component holds.
This is a Level IV case series of 45 young patients (mean age 42) treated for glenohumeral arthritis with hemiarthroplasty plus biologic glenoid resurfacing. Resurfacing used either a lateral meniscal allograft or human acellular dermal tissue matrix. It asks whether the good short-term outcomes hold up at intermediate follow-up.
The young active patient with glenohumeral arthritis is one of the hardest problems in shoulder surgery, and this paper explains why biologic resurfacing has largely fallen out of favor.
The attractive concept was to interpose soft tissue over the glenoid to relieve pain while delaying the day you commit to a glenoid prosthesis. This series shows the concept does not hold up: over half fail by 2.8 years, and the joint space narrows radiographically as the graft degrades.
A useful mental model is that a soft tissue patch cannot survive the compressive and shear loads of an active shoulder, so the underlying bipolar disease keeps progressing.
Note the trap in the outcome scores. Mean ASES, VAS, and SST all improved significantly from baseline, yet the same cohort had a greater than 50% clinical failure rate. Statistically significant improvement from a miserable baseline is not the same as a good result.
Contrast this with the more durable competitors: hemiarthroplasty survival is roughly 92% at 5 years, and total shoulder arthroplasty gives reliable pain relief when the glenoid component holds.