Biologic glenoid, ‘ream-and-run’ among promising techniques for hemiarthroplasty

However, surgeon points to a lack of long-term follow-up as a problem with these new methods.

While new techniques for shoulder hemiarthroplasty may expand the indications for shoulder replacements and show promising results, there is a lack of research detailing the mid- and long-term outcomes of these methods, according to an investigator from Virginia.

At the 9th Annual Advances in Arthritis, Arthroplasty and Trauma Course, Jeffrey H. Berg, MD, described the short-term results of “ream-and-run,” biologic glenoid resurfacing and humeral resurfacing treatments.

“Total shoulder arthroplasty has shown reproducibly good and excellent short- and mid-term results for the treatment of glenohumeral arthritis,” Berg told Orthopedics Today. “However, it is not indicated for isolated humeral disease or for young patients. Long-term glenoid component failure is still a concern. Isolated hemiarthroplasty has good short- and mid-term results if [there is] a concentric glenoid.

“Ream-and-run, biological resurfacing with either hemiarthroplasty or humeral head resurfacing, and isolated humeral head resurfacing have shown promising results in a small number of studies. The problem is that all published results are short- and mid-term with no long-term follow-up,” Berg said.

“Who knows what the future holds. Perhaps you will see arthroscopic glenoid resurfacing and minimally invasive humeral resurfacing,” he added.

Ream and run

Berg noted that an early cadaveric study describing the ream-and-run technique showed that reaming the arthritic glenoid could restore stability. A canine study also showed a restoration of stability and the development of fibrocartilage at 24 weeks. A clinical study on the technique showed significant improvement in 12 out of 12 Simple Shoulder Test functions at a mean of 2.7 years, he said.

Biologic resurfacing has been used in procedures for other joints such as the hip and knee. Berg said that some researchers have described biologic glenoid resurfacing using the anterior shoulder capsule, autogenous fascia lata and Achilles tendon allograft, while more recent techniques have described using a lateral meniscal allograft.

He cited early research by Wayne Z. Burkhead Jr., MD, who investigated biologic resurfacing performed with the anterior capsule, fascial lata and Achilles-tendon allografts. The investigators found five excellent and one satisfactory result at short-term follow-up. However, subsequent mid-term follow-up on the same patients showed results following the usage of anterior capsule to be unsatisfactory.

Biologic resurfacing using meniscal allografts

Recent work by Michael A. Wirth, MD, on biologic resurfacing using lateral meniscal allografts showed statistically significant improvements in pain, function and quality of life, Berg said.

Restoring the precise humeral anatomy is difficult because of its variability, Berg said. “This variability exists in medial and posterior offsets, inclination, retroversion, articular surface radius of curvature and thickness,” he said. “All of this can affect the center of rotation in a three-dimensional manner which can affect kinematics.”

He noted that humeral resurfacing maintains three-dimensional positioning, is bone-sparring and allows for glenoid resurfacing if necessary. Berg cited research by Stephen A. Copeland, FRCS, which compared the outcomes of resurfaced total shoulder arthroplasties and hemiarthroplasties. “The results were similar,” Berg said. “The only revision was in the total shoulder arthroplasty group.”

For more information:
Jeffrey H. Berg, MD, can be reached at Town Center Orthopaedic Associates, 1860 Town Center Drive, Suite 300, Reston, VA 20190, U.S.A.; +1-703-435-6604; e-mail: jhbergmd@mac.com. Orthopedics Today was unable to determine if he has any direct financial interest in any products or companies mentioned in this article.

References:
Berg JH. Shoulder hemiarthroplasty: Who needs the glenoid component? Paper #39. Presented at the 9th Annual Advances in Arthritis, Arthroplasty and Trauma Course. Sept. 10-12, 2008. Arlington, Va.
Burkhead WZ Jr, Hutton KS. Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder. J Shoulder Elbow Surg. 1995;4(4):263-270.
Levy O, Funk L, Sforza G, Copeland SA. Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis. J Bone Joint Surg (Am). 2004;86(3):512-518.
Wirth MA, Southworth C, Larsen MW, et al. The effect of anatomical reconstruction following HA for proximal humerus fractures. Paper #11. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.