The Journal of Bone and Joint Surgery (American). 2008;90:9-19.
doi:10.2106/JBJS.G.01220
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis

Surgical Technique

Sumant G. Krishnan, MD1, John R. Reineck, MD1, Robert J. Nowinski, DO2, Donnis Harrison, MD3 and Wayne Z. Burkhead, MD1

1 Shoulder and Elbow Service, The Carrell Clinic, 9301 North Central Expressway, Suite 400, Dallas, TX 75231. E-mail address for S.G. Krishnan: skrishnan{at}wbcarrellclinic.com
2 Orthopaedic Specialists and Sports Medicine, 1980 Tamarack Road, Newark, OH 43055
3 Bienville Orthopaedic Specialists, 3615 Hospital Road, Pascagoula, MS 39568

Investigation performed at the Shoulder and Elbow Service, The Carrell Clinic, Dallas, Texas

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 727-34, April 2007

DISCLOSURE: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Tornier. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Tornier). Also, a commercial entity (Tornier) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The line drawing in this article is the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

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, thirty-four patients (thirty-six shoulders) who were managed with biologic glenoid resurfacing and humeral head replacement either with cement (ten shoulders) or without cement (twenty-six shoulders) were followed prospectively. The study group included thirty men and four women with an average age of fifty-one years. The diagnoses included primary glenohumeral osteoarthritis (eighteen shoulders), postreconstructive arthritis (twelve), posttraumatic arthritis (five), and osteonecrosis (one). Anterior capsule was used for seven shoulders, autogenous fascia lata for eleven, and Achilles tendon allograft for eighteen. 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 eighteen shoulders, satisfactory for thirteen, and unsatisfactory for five. Glenoid erosion averaged 7.2 mm and appeared to stabilize at five years. There were no revisions for humeral component loosening. Complications included infection (two patients), instability (three 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.

ORIGINAL ABSTRACT CITATION: "Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis. Two to Fifteen-Year Outcomes" (2007;89:727-34).


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