Saturday, September 14, 2013

Failure of meniscal allograft and acellular dermal matrix interposition in treating glenohumeral arthritis

The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis

The authors express worry about the use of total shoulder arthroplasty in young patients because of the risk of early failure of the glenoid component. Similarly, they worry that humeral head replacement without attention to the glenoid may lead to progressive joint space narrowing, glenoid erosion, and diminishing outcomes over time. For these reasons, they and others have explored alternative treatment approaches, such as biologic resurfacing of the glenoid using a lateral meniscus allograft or human acellular dermal tissue matrix for young patients with symptomatic glenohumeral arthritis.

They performed reaming of the glenoid to create a concentric surface with punctate bleeding in hopes of adhesion and healing of the interposed tissue to the native glenoid. The interposition was then fixed to the periphery of glenoid using sutures.

They report the results of 41 of 45 patients with average age 42.2 years (range, 18.1-60.2 years (31 with lateral meniscus and 10 with dermal matrix) available for follow-up at an average of 2.8 years. They defined failure as (1) conversion to a total shoulder arthroplasty or reverse total shoulder arthroplasty, (2) recommendation of conversion to a total shoulder arthroplasty or reverse total shoulder arthroplasty by the treating surgeon, (3) revision surgery for graft removal, or (4) patient-reported disabling pain (VAS ≥ 8) or loss of function, or (5) postoperative ASES score of less than 50 points, or both.

The overall clinical failure rate was 51.2%. The lateral meniscal allograft cohort had a failure rate of 45.2%, with a mean time to failure of 3.4 years. Human acellular dermal tissue matrix interposition had a failure rate of 70.0%, with a mean time to failure of 2.2 years.

We observe that young and active individuals with arthritis present a substantially greater challenge than their older less active counterparts, as previously emphasized in this Blog. Some, but surely not all, of these individuals may merit consideration for a ream and run procedure.

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