Soft-tissue resurfacing of the glenoid in the treatment of glenohumeral arthritis in active patients less than fifty years old.
BACKGROUND
Soft-tissue resurfacing of the glenoid, with arthroplasty of the humeral head, has been proposed as a viable treatment option for younger patients with symptomatic osteoarthritis of the shoulder. The purpose of this study was to evaluate our results with soft-tissue resurfacing of the glenoid in patients with glenohumeral arthritis who were less than fifty years of age, as we were concerned that this type of procedure was leading to poor outcomes.


METHODS
Between 2000 and 2006, thirteen patients with an average age of thirty-four years underwent soft-tissue resurfacing of the glenoid and humeral head arthroplasty. Achilles tendon allograft was used in eleven patients; fascia lata autograft, in one; and anterior shoulder joint capsule, in one. Three patients had resurfacing of the humeral head with a stemless resurfacing implant, and ten patients had a hemiarthroplasty. The patients were followed for a minimum of two years or until failure, and the duration of follow-up averaged forty-eight months. The results were graded with a visual analog pain scale, the subjective shoulder value, and the Constant and Murley score. Radiographic review was performed in order to determine the degree of joint space loss and glenoid erosion.


RESULTS
Ten of the thirteen patients required a revision total shoulder arthroplasty at a mean of fourteen months (range, six to thirty-four months) postoperatively. The principal reasons for revision were persistent pain and a decreased range of motion. Radiographic evaluation at the time of the revision surgery demonstrated loss of joint space and glenoid erosion in all cases. At the revision surgery, the allograft was found to be absent, and thick scar tissue, which may have been a graft remnant, was found at the perimeter of the glenoid. Of the three patients who did not have a revision arthroplasty, one had good function, pain relief, and an improved range of motion; however, the postoperative course of the other two was complicated by infection. One of them had a salvage with early irrigation and débridement as well as intravenous antibiotics, whereas the other underwent resection arthroplasty because of persistent infection.


CONCLUSIONS
Soft-tissue resurfacing of the glenoid with an Achilles tendon allograft combined with humeral head arthroplasty is not a reliable method of treatment of glenohumeral arthritis in an active patient younger than fifty years of age, as the clinical outcome is poor. Moreover, we found no evidence that the graft acts as a durable bearing surface.
Elhassan
Bassem
B
Massachusetts General Hospital, Boston, Massachusetts, USA. elhassan.bassem@mayo.edu
Ozbaydar
Mehmet
M
Diller
David
D
Higgins
Lawrence D
LD
Warner
Jon J P
JJ
D000125:Achilles Tendon / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D019643:Arthroplasty, Replacement; D001182:Arthroscopy; D003646:Debridement; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy; D010149:Postoperative Pain / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint; D014184:Transplantation, Homologous; D055815:Young Adult