The primary indication for shoulder arthroplasty is painful glenohumeral arthritis in patients aged older than 60 years who have failed conservative measures. It has been well established in the literature that patients younger than 50 years tend to have worse outcomes with shoulder arthroplasty. In young, active patients, the documented incidence of glenoid loosening is about 39% in midterm to long-term follow-up. In an attempt to provide pain relief and avoid a glenoid component, shoulder hemiarthroplasty (HA) alone, without a glenoid component, is an option in young, active patients who participate in sports and heavy labor. However, progressive glenoid erosion and pain have been found to be a primary mode of failure for young patients with shoulder HA. To this end, biological resurfacing (BR) of the glenoid with Achilles tendon allograft, lateral meniscal allograft, autogenous fascia lata, or extra-cellular matrix products have been used as an interposition arthroplasty on the glenoid side in conjunction with humeral HA. This was used to provide a ‘‘wettable’’ surface on the glenoid side and avoid metal-on-bone contact and glenoid erosion and pain. Creighton noted significant decreases in force at the glenoid surface under stress testing of a lateral meniscal allograft in a cadaveric model, which supports the rationale for BR.
The purpose of this study was to evaluate retrospectively 2 cohorts of patients: the first group received a HA alone, and the second received a HA with BR by the senior authors (B.J.C., G.P.N., N.N.V., and A.A.R.) at a large, high- volume shoulder surgical practice. The working hypothesis was that the BR group would have improved clinical results, less glenoid wear in early to midterm follow-up, and fewer conversions to total shoulder arthroplasty (TSA).