Sunday, March 30, 2014

Biologic resurfacing of the glenoid - high failure rate

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

These authors evaluated 45 patients (mean age 42) having biologic resurfacing of the glenoid using a lateral meniscus allograft or human acellular dermal tissue matrix; 41 were available for follow-up at a mean of 2.8 years. Lateral meniscal allograft resurfacing was used in 31 patients and human acellular dermal tissue matrix interposition in 10. 29 patients had primary osteoarthritis, 7 had post traumatic arthritis, 7 had capsulorraphy arthropathy, 1 had chondrolysis, and 1 had avascular necrosis of the humeral head.

Failure was defined as conversion to a total or reverse total shoulder arthroplasty, a recommendation for this conversion, revision surgery for graft removal, or poor comfort and function after the procedure.

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. Note that a followup time limited to 2 years would have missed over half of these failures.

Comment: Biological resurfacing has been the topic of a number of prior posts:
These articles indicate that it is a technically demanding procedure based on the hope that the interpositional material will remain fixed to the glenoid and endure under the forces applied by the prosthetic humeral head on the underlying glenoid bone. These articles indicate that this hope is often not realized.

For selected patients, the ream and run procedure may be a better option.


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