Background: Biologic glenoid resurfacing was developed in 1988 as an
alternative to total shoulder arthroplasty in selected (usually younger)
patients with primary, posttraumatic, or postreconstructive glenohumeral
arthritis. A variety of biologic surfaces, including anterior capsule,
autogenous fascia lata, and Achilles tendon allograft, have been combined with
a humeral hemiarthroplasty.
Methods: From November 1988 to November 2003, thirty-four patients
(thirty-six shoulders) who were managed with biologic glenoid resurfacing and
humeral head replacement either with cement (ten shoulders) or without cement
(twenty-six shoulders) were followed prospectively. The study group included
thirty men and four women with an average age of fifty-one years. The
diagnoses included primary glenohumeral osteoarthritis (eighteen shoulders),
postreconstructive arthritis (twelve), posttraumatic arthritis (five), and
osteonecrosis (one). Anterior capsule was used for seven shoulders, autogenous
fascia lata for eleven, and Achilles tendon allograft for eighteen. All
shoulders were assessed clinically and with serial radiographs.
Results: The mean American Shoulder and Elbow Surgeons score was 39
points preoperatively and 91 points at the time of the most recent follow-up.
According to Neer's criteria, the result was excellent for eighteen shoulders,
satisfactory for thirteen, and unsatisfactory for five. Glenoid erosion
averaged 7.2 mm and appeared to stabilize at five years. There were no
revisions for humeral component loosening. Complications included infection
(two patients), instability (three patients), brachial plexitis (one patient),
and deep-vein thrombosis (one patient). Factors that appeared to be associated
with unsatisfactory results were the use of capsular tissue as the resurfacing
material and infection.
Conclusions: Biologic resurfacing of the glenoid can provide pain
relief similar to total shoulder arthroplasty. It allows selected younger
patients to maintain an active lifestyle, including weight-lifting and manual
work, without the risk of polyethylene wear. On the basis of this and previous
reviews, we currently recommend Achilles tendon allograft as the preferred
resurfacing material when this option is chosen.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.