Saturday, March 16, 2013

Foreign body reaction to glenoid resurfacing with GraftJacket

Foreign Body Reaction to Acellular Dermal Matrix Allograft in Biologic Glenoid Resurfacing

There has been interest in biologic glenoid resurfacing for young patients with glenohumeral arthritis. Some have advocated the use of an acellular dermal matrix (GraftJacket) as a biological interposition between the humeral head prosthesis and glenoid bone. 

These authors present two cases of young women patients having a shoulder resurfacing + a GraftJacket interposition. Interestingly, one of the two had chondrolysis from a pain pump inserted at a prior procedure.

These two shoulders had a foreign body giant cell reaction that required revision surgery. At revision both shoulders had a well-fixed humeral component and a dense, erythematous, synovitic membrane overlying the glenoid. Pathology specimens showed a reactive synovium, chronic inflammation, and foreign body giant cell reaction. After d├ębridement and conversion to total shoulder arthroplasty, both patients continued to be pain-free at greater than 1-year followup.

The authors opine: "Given the lack of data to indicate an advantage to biologic resurfacing of the glenoid over hemiarthroplasty alone, resurfacing should not introduce significant additional surgical complications."

It is difficult to imagine how an interpositional graft could hold up between a metal humeral head and a bony glenoid.
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