Monday, February 20, 2012

Biological glenoid resurfacing for glenohumeral osteoarthritis

“Biological glenoid resurfacing for glenohumeral osteoarthritis” refers to a groups of procedures in which a biological material (anterior capsule autograft, Achilles tendon allograft, fascia lata allograft, lateral meniscus allograft, or a biological scaffold material is interposed between a humeral prosthesis and the bone of the glenoid.  While the concept may have some appeal, it seems unlikely that the interposed material will heal to and actually resurface the glenoid and unlikely that the interposed material will survive the substantial grinding loads applied by the hard opposing surfaces of metal and bone. So, we’ve not used this form of treatment for patients with glenohumeral arthritis.

Thus it was of interest to receive these two emails less than one week apart:

(1) “I am reaching out to you on behalf of my husband who has a failed shoulder replacement.  ….. The original replacement was with Dr. xxx and could be considered a partial replacement, as the humeral head was replaced with titanium, but the socket was cleaned out and a donor meniscus was used in the socket.” 

(2) “I had a shoulder replacement a few years ago using cadaver meniscus. I really wanted the ream and run, and had done extensive research on the various options, but the doctor said he had better results with this procedure and that I would be able to do anything with no limitations. In reality, I’m very limited in what I can do. I have always been extremely active, lifting, running, doing all the house and yard work, etc. Now, I can’t hammer a nail or rake the leaves. Anyway, this shoulder makes the worst noises, and doesn’t feel at all very tight.”

Of course any operation can have a poor outcome, but these two emails prompted interest in the October 2011 review article in JSES entitled “biological glenoid resurfacing for glenohumeral osteoarthritis”.  In this review the authors reviewed the published evidence in support of biological resurfacing. They found seven articles meeting their inclusion criteria. The patients were a demanding group: average age of 46 years, half having had previous surgery, and predominantly male gender. Mean follow-up was 4 years.  On average patients had improved comfort and function. 26% had reoperations.

In consideration of the recognized difficulties in achieving a good result in young male patients with their diverse types of arthritis, multiple prior surgeries, these results appear reasonable; however, no data are presented comparing this procedure to other surgeries in similar patients.

Our preference for the treatment of glenohumeral arthritis in active individuals who wish to avoid the risk of failure of the plastic glenoid component in total shoulder arthroplasty remains the ream and run procedure. In previous posts we have documented the results in younger individuals. In contrast to the situation with biological resurfacing, the ream and run avoids concern about the failure of a piece of devitalized tissue inserted between a metal prosthesis and the bone of the glenoid.


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