Humeral hemiarthroplasty with biologic glenoid resurfacing shows good intermediate-term results

Use of anterior capsule autograft and infection were associated with unsatisfactory results.

Biologic glenoid resurfacing combined with humeral hemiarthroplasty can provide younger, more active patients with pain relief and functional results comparable to total shoulder arthroplasty for glenohumeral arthritis, according to a study by researchers in Texas.

Sumant G. Krishnan, MD, and colleagues at the Carrell Clinic in Dallas evaluated the intermediate-term results for 36 shoulders in 34 patients treated with the procedure at a mean age of 51 years and who had at least 2 years follow-up. They published their findings in the American edition of the Journal of Bone and Joint Surgery.

"All ... patients were selected for this technique on the basis of age and/or a high functional demand of the shoulder that would raise substantial concern about potential loosening of a conventional polyethylene glenoid component," the study authors wrote.

Three types of graft materials were used for glenoid resurfacing, including anterior glenohumeral capsule in seven shoulders (19%), autogenous fascia lata in 11 shoulders (31%) and Achilles tendon allograft in 18 shoulders (50%), according to the study. Surgeons performed a subscapularis tendon and anterior capsule Z-plasty in the first 18 shoulders. "In the second 18 shoulders, an Achilles tendon allograft was used as the resurfacing graft in order to reduce graft harvest-site morbidity and to increase the thickness of tissue available for resurfacing," the authors wrote.

At 2 years minimum follow-up, the mean American Shoulder and Elbow Surgeons score had improved to 91 points from 39 points preoperatively. In addition, Neer scores indicated that 18 shoulders had excellent results, 13 had satisfactory results and only five had unsatisfactory outcomes, according to the study.

Overall, mean pain scores decreased to 2.1 points from 7.7 points preoperatively, with excellent pain relief in 22 shoulders and good pain relief in nine, the authors noted.

Range of motion also increased, from 70° of active anterior elevation preoperatively to 140° postoperatively and from 5° of external rotation preoperatively to 50° postoperatively. At latest follow-up, 29 patients (85%) had returned to performing their original activities, according to the study.

"With the numbers available, there was no apparent difference between the 18 shoulders in the autogenous graft group and the 18 shoulders in the allograft group with regard to the mean glenohumeral joint space. However, no shoulder in the allograft group demonstrated a joint space of ±1 mm, whereas 17 of the 18 shoulders in the autogenous graft group demonstrated a joint space of ±1 mm," the authors reported.

Complications included three cases of instability, two cases of infection, one case of brachial plexitis and one cases of upper-extremity deep vein thrombosis.

Use of anterior capsule for the graft material and infection were associated with unsatisfactory results, the authors noted.

"On the basis of the results in the current series, we believe that autogenous tissue is not the optimal resurfacing tissue. While good results can be obtained with the use of autogenous fascia lata, we do not believe that it provides a durable bearing surface for reproducible outcomes with this operation," they wrote.

For more information:
Krishnan SG, Nowinski RJ, Harrison D, Burkhead WZ. Humeral hemiarthroplasty with biologic resurfacing of the glenoid for glenohumeral arthritis. Two- to fifteen-year outcomes. J Bone Joint Surg Am. 2007;89-A:727-734.