title: Foreign body reaction to acellular dermal matrix allograft in biologic glenoid resurfacing.
abstract: BACKGROUND
  Biologic glenoid resurfacing is a treatment option for young patients with glenohumeral arthritis. An optimal synthetic graft for glenoid resurfacing should allow repopulation with host cells, be durable enough to tolerate suture fixation and forces across the joint, and present no host inflammatory response. We report two cases of giant cell reaction to GraftJacket(®) after biologic glenoid resurfacing.
  
  
  METHODS
  Two patients who underwent hemiarthroplasty and biologic glenoid resurfacing using GraftJacket(®) had a foreign body giant cell reaction that required revision surgery. Intraoperatively, both patients were observed to have a well-fixed humeral component and a dense, erythematous, synovitic membrane overlying the glenoid. Pathology specimens showed a benign reactive synovium, chronic inflammation, and foreign body giant cell reaction. After débridement and conversion to total shoulder arthroplasty, both patients continued to be pain-free at greater than 1-year followup.
  
  
  METHODS
  Multinucleated giant cell and mononuclear cell responses have been observed in an animal model after use of GraftJacket(®). Although the use of acellular matrix-based scaffold for biologic glenoid resurfacing is not new, the possibility of foreign body reaction as a source of persistent symptoms has not been described.
  
  
  CONCLUSIONS
  Given the lack of data to indicate an advantage to biologic resurfacing of the glenoid over hemiarthroplasty alone, resurfacing should not introduce significant additional surgical complications. We suggest foreign body reaction be considered in the differential diagnosis for a persistently painful shoulder after biologic glenoid resurfacing using an acellular allograft patch.
authors.affiliation: Department of Orthopedic Surgery, Washington University, St Louis, MO 63110, USA.
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
authors.forename: Christopher
authors.initials: C
authors.lastname: Melnic
authors.forename: G Russell
authors.initials: GR
authors.lastname: Huffman
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects*; D000328:Adult; D001168:Arthritis / Q000175:diagnosis / Q000601:surgery*; D001182:Arthroscopy; D001706:Biopsy; D003646:Debridement; D005260:Female; D005549:Foreign-Body Reaction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D062785:Hemiarthroplasty; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology; D012086:Reoperation; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology; D016038:Skin Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome