Wednesday, August 9, 2017

Which patients with shoulder arthritis are likely to benefit from Interpositional human dermal allograft?

Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft

These authors reported results of arthroscopic glenoid resurfacing for glenohumeral arthritis at an average of 60 month clinical followup or until revision. Patients lost to follow-up and those included in a prior study were excluded.

The visual analog scale pain score improved from a median of 7 to 2. Median ASES score improved from 47 to 76; active forward elevation improved from 110 to 140.

The rate of revision to prosthetic arthroplasty was 23% after a mean of 45 months. The mean age of revised shoulders (60 years) was higher than that of surviving shoulders (53 years). The preoperative ASES score of revised shoulders (34) was lower than that of surviving shoulders (47). 
Revisions included hemiarthroplasty in 3 shoulders, anatomic total shoulder arthroplasty in 4, and reverse total shoulder arthroplasty in 3.

With multivariate analysis, exact odds ratios for age and preoperative ASES score as risk factors for revision were 1.3 (95% CI, 1.0-1.6; P . .02) and 0.9 (95% CI, 0.8-1.0; P . .003), respectively.

Comment: In considering the appropriate use for this procedure, it would be of interest to know the effect of glenoid type (e.g. A2 vs B2), sex, and prior surgery on the outcomes. It would also be of interest to know the relationship of radiographic joint space at followup to the clinical outcome. Finally, it would be of interest to know the outcomes of revisions: were they comparable to the results that would have been expected if the arthroplasty was performed primarily, or were the results inferior when performed as a revision?

The reader may also be interested in these posts:

Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.