The Journal of Bone and Joint Surgery (American). 2009;91:419-424.
doi:10.2106/JBJS.H.00318
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Soft-Tissue Resurfacing of the Glenoid in the Treatment of Glenohumeral Arthritis in Active Patients Less Than Fifty Years Old

Bassem Elhassan, MD1, Mehmet Ozbaydar, MD2, David Diller, BA2, Lawrence D. Higgins, MD3 and Jon J.P. Warner, MD2

1 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address: elhassan.bassem{at}mayo.edu
2 Division of Shoulder Surgery, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for M. Ozbaydar: mozbaydar{at}partners.org. E-mail address for D. Diller: ddiller{at}partners.org. E-mail address for J.J.P. Warner: jwarner{at}partners.org
3 Sports Medicine and Shoulder Service, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address: ldhiggins{at}partners.org

Investigation performed at Massachusetts General Hospital, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. 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 (Zimmer). Also, a commercial entity (Zimmer) 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.

Background: Soft-tissue resurfacing of the glenoid, with arthroplasty of the humeral head, has been proposed as a viable treatment option for younger patients with symptomatic osteoarthritis of the shoulder. The purpose of this study was to evaluate our results with soft-tissue resurfacing of the glenoid in patients with glenohumeral arthritis who were less than fifty years of age, as we were concerned that this type of procedure was leading to poor outcomes.

Methods: Between 2000 and 2006, thirteen patients with an average age of thirty-four years underwent soft-tissue resurfacing of the glenoid and humeral head arthroplasty. Achilles tendon allograft was used in eleven patients; fascia lata autograft, in one; and anterior shoulder joint capsule, in one. Three patients had resurfacing of the humeral head with a stemless resurfacing implant, and ten patients had a hemiarthroplasty. The patients were followed for a minimum of two years or until failure, and the duration of follow-up averaged forty-eight months. The results were graded with a visual analog pain scale, the subjective shoulder value, and the Constant and Murley score. Radiographic review was performed in order to determine the degree of joint space loss and glenoid erosion.

Results: Ten of the thirteen patients required a revision total shoulder arthroplasty at a mean of fourteen months (range, six to thirty-four months) postoperatively. The principal reasons for revision were persistent pain and a decreased range of motion. Radiographic evaluation at the time of the revision surgery demonstrated loss of joint space and glenoid erosion in all cases. At the revision surgery, the allograft was found to be absent, and thick scar tissue, which may have been a graft remnant, was found at the perimeter of the glenoid. Of the three patients who did not have a revision arthroplasty, one had good function, pain relief, and an improved range of motion; however, the postoperative course of the other two was complicated by infection. One of them had a salvage with early irrigation and débridement as well as intravenous antibiotics, whereas the other underwent resection arthroplasty because of persistent infection.

Conclusions: Soft-tissue resurfacing of the glenoid with an Achilles tendon allograft combined with humeral head arthroplasty is not a reliable method of treatment of glenohumeral arthritis in an active patient younger than fifty years of age, as the clinical outcome is poor. Moreover, we found no evidence that the graft acts as a durable bearing surface.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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