Advertisement

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

      Purpose

      To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up.

      Methods

      We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision.

      Results

      Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 to 2 (median difference [Δ], 4 [95% CI, 3-6]; P < .0001), representing pain relief similar to total shoulder arthroplasty in young patients. Improvements in the median ASES score (from 47 to 76; Δ, 28 [95% CI, 17-40]; P < .0001), active forward elevation (from 110° to 140°; Δ, 20° [95% CI, 10°-35°]; P < .0001), and active external rotation (from 0° to 20°; Δ, 10° [95% CI, 5°-20°]; P < .0001) were noted. The mean age of revised shoulders (60 years [95% CI, 54-66 years]) was higher than that of surviving shoulders (53 years [95% CI, 50-57 years], P = .005). The preoperative ASES score of revised shoulders (34 [95% CI, 27-42]) was lower than that of surviving shoulders (47 [95% CI, 43-51], P = .006). No complications were noted.

      Conclusions

      AGR with dermal allograft is a safe option for joint preservation in selected patients, provides pain relief, and has an acceptable rate of revision to prosthetic arthroplasty at short-term to midterm follow-up. Increased age and lower preoperative ASES score were risk factors for failure of AGR.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sperling J.W.
        • Cofield R.H.
        • Rowland C.M.
        Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results.
        J Bone Joint Surg Am. 1998; 80: 464-473
        • Levy J.C.
        • Virani N.A.
        • Frankle M.A.
        • Cuff D.
        • Pupello D.R.
        • Hamelin J.A.
        Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2008; 17: 380-388
        • Bartelt R.
        • Sperling J.W.
        • Schleck C.D.
        • Cofield R.H.
        Shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis.
        J Shoulder Elbow Surg. 2011; 20: 123-130
        • Schoch B.
        • Schleck C.
        • Cofield R.H.
        • Sperling J.W.
        Shoulder arthroplasty in patients younger than 50 years: Minimum 20-year follow-up.
        J Shoulder Elbow Surg. 2015; 24: 705-710
        • Denard P.J.
        • Raiss P.
        • Sowa B.
        • Walch G.
        Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis.
        J Shoulder Elbow Surg. 2013; 22: 894-900
        • Hawker G.A.
        Who, when, and why total joint replacement surgery? The patient's perspective.
        Curr Opin Rheumatol. 2006; 18: 526-530
        • Hudak P.L.
        • Clark J.P.
        • Hawker G.A.
        • et al.
        “You're perfect for the procedure! Why don't you want it?” Elderly arthritis patients' unwillingness to consider total joint arthroplasty surgery: A qualitative study.
        Med Decis Making. 2002; 22: 272-278
        • Brislin K.J.
        • Savoie III, F.H.
        • Field L.D.
        • Ramsey J.R.
        Surgical treatment for glenohumeral arthritis in the young patient.
        Tech Shoulder Elbow Surg. 2004; 5: 165-169
        • Savoie F.H.
        • Brislin K.J.
        • Argo D.
        Arthroscopic glenoid resurfacing as a surgical treatment for glenohumeral arthritis in the young patient: Midterm results.
        Arthroscopy. 2009; 25: 864-871
        • Bhatia D.N.
        • van Rooyen K.S.
        • du Toit D.F.
        • de Beer J.F.
        Arthroscopic technique of interposition arthroplasty of the glenohumeral joint.
        Arthroscopy. 2006; 22: 570.e571-570.e575
        • de Beer J.F.
        • Bhatia D.N.
        • van Rooyen K.S.
        • Du Toit D.F.
        Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1767-1773
        • Pennington W.T.
        • Bartz B.A.
        Arthroscopic glenoid resurfacing with meniscal allograft: A minimally invasive alternative for treating glenohumeral arthritis.
        Arthroscopy. 2005; 21: 1517-1520
        • Millett P.J.
        • Horan M.P.
        • Pennock A.T.
        • Rios D.
        Comprehensive arthroscopic management (CAM) procedure: Clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis.
        Arthroscopy. 2013; 29: 440-448
        • Richards D.P.
        • Burkhart S.S.
        Arthroscopic debridement and capsular release for glenohumeral osteoarthritis.
        Arthroscopy. 2007; 23: 1019-1022
        • Gobezie R.
        • Lenarz C.J.
        • Wanner J.P.
        • Streit J.J.
        All-arthroscopic biologic total shoulder resurfacing.
        Arthroscopy. 2011; 27: 1588-1593
        • Weinstein D.M.
        • Bucchieri J.S.
        • Pollock R.G.
        • Flatow E.L.
        • Bigliani L.U.
        Arthroscopic debridement of the shoulder for osteoarthritis.
        Arthroscopy. 2000; 16: 471-476
        • Savoie III, F.H.
        • O'Brien M.J.
        Glenohumeral resurfacing.
        in: Abrams J.S. Bell R.H. Tokish J.M. Advanced reconstruction: Shoulder 2. Ed 2. American Academy of Orthopaedic Surgeons, Rosemont, IL2016: 389-398
        • Samilson R.L.
        • Prieto V.
        Dislocation arthropathy of the shoulder.
        J Bone Joint Surg Am. 1983; 65: 456-460
        • Michener L.A.
        • McClure P.W.
        • Sennett B.J.
        American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness.
        J Shoulder Elbow Surg. 2002; 11: 587-594
        • Gilbart M.K.
        • Gerber C.
        Comparison of the subjective shoulder value and the Constant score.
        J Shoulder Elbow Surg. 2007; 16: 717-721
        • Smith A.M.
        • Barnes S.A.
        • Sperling J.W.
        • Farrell C.M.
        • Cummings J.D.
        • Cofield R.H.
        Patient and physician-assessed shoulder function after arthroplasty.
        J Bone Joint Surg Am. 2006; 88: 508-513
        • Sayegh E.T.
        • Mascarenhas R.
        • Chalmers P.N.
        • Cole B.J.
        • Romeo A.A.
        • Verma N.N.
        Surgical treatment options for glenohumeral arthritis in young patients: A systematic review and meta-analysis.
        Arthroscopy. 2015; 31: 1156-1166.e8
        • Raiss P.
        • Aldinger P.R.
        • Kasten P.
        • Rickert M.
        • Loew M.
        Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis.
        J Bone Joint Surg Br. 2008; 90: 764-769
        • Wajon A.
        • Vinycomb T.
        • Carr E.
        • Edmunds I.
        • Ada L.
        Surgery for thumb (trapeziometacarpal joint) osteoarthritis.
        Cochrane Database Syst Rev. 2015; : CD004631
        • De Roo N.
        • Van Doorne L.
        • Troch A.
        • Vermeersch H.
        • Brusselaers N.
        Quantifying the outcome of surgical treatment of temporomandibular joint ankylosis: A systematic review and meta-analysis.
        J Craniomaxillofac Surg. 2016; 44: 6-15
        • Larson A.N.
        • Morrey B.F.
        Interposition arthroplasty with an Achilles tendon allograft as a salvage procedure for the elbow.
        J Bone Joint Surg Am. 2008; 90: 2714-2723
        • Cheng S.L.
        • Morrey B.F.
        Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty.
        J Bone Joint Surg Br. 2000; 82: 233-238
        • Puskas G.J.
        • Meyer D.C.
        • Lebschi J.A.
        • Gerber C.
        Unacceptable failure of hemiarthroplasty combined with biological glenoid resurfacing in the treatment of glenohumeral arthritis in the young.
        J Shoulder Elbow Surg. 2015; 24: 1900-1907
        • Elhassan B.
        • Ozbaydar M.
        • Diller D.
        • Higgins L.D.
        • Warner J.J.
        Soft-tissue resurfacing of the glenoid in the treatment of glenohumeral arthritis in active patients less than fifty years old.
        J Bone Joint Surg Am. 2009; 91: 419-424
        • Strauss E.J.
        • Verma N.N.
        • Salata M.J.
        • et al.
        The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis.
        J Shoulder Elbow Surg. 2014; 23: 409-419