Wednesday, October 14, 2015

Shoulder arthroplasty using meniscal allograft resurfacing of the glenoid

Humeral head arthroplasty and meniscal allograft resurfacing of the glenoid.

These authors report the two year outcomes of 27 patients having humeral head arthroplasty and meniscal allograft resurfacing of the glenoid. This procedure is intended " to avoid the potential complications of polyethylene use in younger patients with glenohumeral arthritis".

When a nonconcentric and/or eroded glenoid was encountered, it was carefully contoured with a reamer to provide a smooth, concentric surface. The custom reamer size was chosenwith a diameter 2 mm larger than the selected humeral implant size.

Clinical outcomes were significantly improved at the time of the latest follow-up. However, over the time frame of the study, there was radiographic evidence of glenohumeral joint-space narrowing, raising concern for both the long-term functional outcome and the durability of the glenoid bone-sparing effect.

The estimated ten-year survival rate was 56.3%. Nine (30%) of the original thirty patients were known to have undergone reoperation.
Comment: The authors have provided their data on 27 shoulders in a manner that enables comparison with other approaches to glenoid humeral arthroplasty: plotting the SST score as a function of time after the procedure:

These outcomes can be compared to those with the ream and run procedure, as shown in this prior post..

The addition of a meniscal allograft after glenoid reaming adds to the complexity and duration of the surgical procedure.  These results with meniscal allograft do not appear to be superior (or even comparable) to those of the ream and run procedure. Previous posts have expressed concern about the high revision rate after meniscal allograft (see here, here, and most recently here.


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