These authors used GraftJacket for glenoid resurfacing combined with humeral resurfacing or a stemmed hemiarthroplasty in 6 patients with a mean age of 47 years (34-57 years). Before GraftJacket was available, they treated 5 patients with a meniscal allograft and 6 with capsular interposition arthroplasty.
At a mean of 16 months (9-22 months) after the GraftJacket was implanted, 5 of the 6 patients were revised to a total shoulder arthroplasty or a reverse total shoulder arthroplasty. The sixth patient was dissatisfied but declined further surgery. The mean relative, preoperative Constant score decreased from 35% (range, 13%-61%) to 31% (range, 15%-43%) at revision or latest follow-up.
Of the 5 patients with meniscal allograft, 3 underwent revision at a mean of 22 months (range, 12-40 months), and 4 of the 6 patients with capsular interposition were revised at a mean of 34 months (range, 23-45 months). The mean relative Constant scores preoperatively and at revision or latest follow-up were 44% (range, 19%-68%) and 58% (range, 9%-96%) for the meniscal allograft patients and 47% (range, 38%-62%) and 63% (range, 32%-92%) for the capsular interposition cases.
Interestingly, only 3 of these patients had B2 glenoids.
Comment: We have previously documented that shoulder arthritis in young individuals is challenging for three reasons: (1) more complex pathology (AVN, chondrolysis, post-surgical arthritis, post-traumatic arthritis, etc), (2) greater patient expectations, and (3) greater longevity of the patient. Almost all of these patients were under 50 years of age. 13 had dislocation arthropathy, one had static posterior subluxation, one had post traumatic AVN, 13 had a history of instability. Many had had prior surgery for instability. Their Table II shows that many of these surgeries were big: bone block procedures, Latarjet procedures, glenoid osteotomies, and humeral rotational osteotomies!
Understandably surgeons are searching for approaches to shoulder arthroplasty that are more durable than a total shoulder with its recognized rate of glenoid component failure and its obligatory sacrifice of glenoid bone stock. To whit, a quote from these authors "glenoid component loosening has remained a major concern and accounts for 32% of the complications after TSA, occurring in up to
44% of patients and leading to revision in at least 0.8% of TSAs per year."
44% of patients and leading to revision in at least 0.8% of TSAs per year."
The concept of interposing a human dermal collagen allograft, allograft meniscus or capsule in between the humeral head and the glenoid reminds us of a mortar and pestle
The interposed tissue cannot be expected to hold up against a pestle applying a force of approximately one times body weight.
In our practice we continue to manage patients with the conditions described in this article using the ream and run procedure, in that the ream and run is free of the risks of biological interposition or a plastic glenoid and in that it preserves glenoid and humeral bone stock. The results of this procedure in a large series are well documented - see this link.
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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
See from which cities our patients come.
See the countries from which our readers come on this post.
