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Scientific Articles   |    
Humeral Head Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid
Michael A. Wirth, MD1
1 University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229. E-mail address: wirth@uthscsa.edu
View Disclosures and Other Information
Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. The author, or a member of his immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.
Investigation performed at the University of Texas Health Science Center at San Antonio, San Antonio, Texas

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 May 01;91(5):1109-1119. doi: 10.2106/JBJS.H.00677
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Abstract

Background: Biological glenoid resurfacing with prosthetic humeral head replacement has been suggested as a means to avoid the potential complications of polyethylene use in younger patients with glenohumeral arthritis. The purposes of this report were (1) to describe a technique that was developed to facilitate biological resurfacing of the glenoid with use of meniscal allograft tissue and (2) to report the effectiveness of hemiarthroplasty in conjunction with meniscal allograft glenoid resurfacing.

Methods: Thirty patients (thirty shoulders) with glenohumeral arthritis were treated with hemiarthroplasty and lateral meniscal allograft resurfacing of the glenoid. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort, and function and with use of patient self-assessments including the American Shoulder and Elbow Surgeons score and the Simple Shoulder Test. A detailed radiographic analysis was performed to evaluate glenohumeral subluxation, glenoid bone loss, and the glenohumeral joint space.

Results: Twenty-seven patients (twenty-seven shoulders) were followed for a minimum of two years. The mean duration of follow-up was three years. For the Simple Shoulder Test and the visual analog scale measures for level of pain, pain at rest, and pain with strenuous activity, the results at the final follow-up evaluation were significantly better than the preoperative results. Similarly, all ten functions of the American Shoulder and Elbow Surgeons questionnaire were significantly improved at the time of the latest follow-up. Over the time frame of the study, there was radiographic evidence of glenohumeral joint-space narrowing.

Conclusions: Lateral meniscal allograft resurfacing of the glenoid can protect the glenoid from erosion, can minimize glenohumeral subluxation, and is associated with significant pain relief and improved function for two to five years when used in conjunction with hemiarthroplasty in younger patients with glenohumeral arthritis. However, the progressive decrease in glenohumeral joint space noted radiographically raises concern for both the long-term functional outcome and the durability of the glenoid bone-sparing effect.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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