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Hyaluronic acid membrane helps restore shoulder function in early glenohumeral arthritis
SAN DIEGO, USA — Shoulder function in patients suffering from early arthritis can be improved through the introduction of an engineered hyaluronic acid membrane combined with shoulder debridement and microfracture surgery, according to a study presented here.
The findings were shared by Giuseppe Porcellini, MD, at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Porcellini said that treating primary shoulder arthritis comes down to the use of several surgical options, including arthroscopic joint debridement and arthroscopic resurfacing using graft or engineered membranes. He described why previous experience with engineered hyaluronic acid membranes pointed toward potential use in the treatment of shoulder arthritis.
“The idea was to apply the membrane in this type of lesion for glenohumeral arthritis,” he said. “The membrane is chondrocyte compatible and easy to insert. The aim of the study was to highlight clinical and radiological differences between the two surgical approaches with 2 years of follow-up.”
Study group
Porcellini’s group studied 24 consecutive patients affected by early glenohumeral arthritis. The patients were split into two groups. Group A, a control group of 13 patients, was treated with debridement, capsular release and microfracture. The remaining 11 patients were in group B, which received the same procedure with the added interposition of a hyaluronic acid-engineered membrane.
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Images: Porcellini G |
The patients all received preoperative imaging — both radiographs and MRI — and were further evaluated through SST and Constant scores. Inclusion criteria for the study were arthritis at Samilson stage I or II, loss of forward elevation less than 40· and loss of external rotation less than 30°, Porcellini reported. Cartilaginous defects were classified in the study as being focal, total, monopolar or bipolar.
Follow-up examinations were performed at 3, 6, 12 and 24 months postoperatively. Radiographs were taken at the 2-year follow-up.
Improvement in both groups
“We have improved in both of the groups,” Porcellini said, adding that although 21 patients (87.5%) saw “good outcomes,” 3 patients had poor outcomes related to the progression of arthritis. Patients within group B displayed superior range of motion recovery, Constant pain sub-score and SST.
“There was no statistical difference between preoperative and postoperative glenohumeral distance in both groups,” he said.
The group concluded that in the early stages of glenohumeral arthritis, a combination of debridement, capsular release and microfracture can lead to satisfactory outcomes. Introducing an engineered hyaluronic acid membrane, they noted, appears to increase these results and offer both more pain relief and range of motion recovery.
Still, Porcellini said, it is important to examine patients carefully before choosing to go with any one particular treatment.
“The literature describes very well the indications and contraindications, so I think it is important before making a decision to classify clinical symptoms, radiological findings and activity level,” he said. — by Robert Press
Reference:
- Porcellini G, Campi F, Bodanki CS, Cesari E, Paladini P. Arthroscopic treatment of early glenohumeral arthritis. Paper #371. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego, USA.
- Giuseppe Porcellini, MD, can be reached at Unit of Shoulder and Elbow Surgery, Ospedale Civile, Via L. Van Beethoven 46 Cattolica, Rimini, Italy; email: gporcellini@tin.it.
- Disclosure: Porcellini has no relevant financial disclosures.
