The High Failure Rate of Biologic Resurfacing of the Glenoid in Young Patients with Glenohumeral Arthritis
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Although total shoulder arthroplasty is becoming more common and has been reported as a reliable treatment for pain secondary to glenohumeral degenerative disease, results in younger patients have not been as favorable and concerns remain regarding early failure of the glenoid component. Humeral head replacement alone has been reported to provide short-term pain relief and improved function, but studies with longer follow-up have demonstrated progressive joint space narrowing, glenoid erosion, and diminishing outcomes over time. For these reasons, alternative treatment methods have been investigated for young patients with symptomatic glenohumeral arthritis.
First proposed by Burkhead and Hutton in 1988, biologic resurfacing of the glenoid, combined with hemiarthroplasty, has been used in the treatment of glenohumeral arthritis in young patients, with variable results. In their initial series, interposition of soft tissue between the humeral head implant and the native glenoid provided pain relief and improvement in shoulder range of motion at 2 years of follow-up.
As experience with biologic glenoid resurfacing has increased, other interposition options have been used, including Achilles tendon allografts and, more recently, lateral meniscal allografts and processed tissue grafts such as human acellular dermal tissue matrix (Graftjacket regenerative tissue matrix; Wright Medical Technology, Arlington, TN, USA). Durability of biologic glenoid resurfacing was reported by Krishnan in their 2- to 15-year follow-up of 36 patients. Other studies, however, have reported contrasting results, with a rapid deterioration in postoperative functional outcome, return of pain, and a high rate of conversion to total shoulder arthroplasty.
A short-term follow-up evaluation of 30 patients treated with lateral meniscal allograft resurfacing of the glenoid combined with hemiarthroplasty was published in 2007 from our institution. At a mean follow-up of 18 months, significant improvements were noted in American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, visual analog scale (VAS) pain scores, and shoulder range of motion parameters. Complications requiring revision surgery occurred in 5 patients (17%) within the first postoperative year; however, despite this incidence, 94% of study patients reported satisfaction with their clinical outcome and would have the procedure again if necessary. The current investigation re-evaluated these patients at intermediate-term follow-up, reporting their current clinical status and the incidence of failure of biologic resurfacing. The analysis also included a group of patients treated with human acellular dermal tissue matrix as their soft tissue interposition with a similar duration of follow-up. We hypothesized that the clinical outcomes seen in our short-term evaluation would diminish with longer-term follow-up, highlighted by a high incidence of revision surgery in patients treated with lateral meniscal allograft as well as those treated with human acellular dermal tissue matrix resurfacing of the glenoid.
Full Article: The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis
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