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Arthroscopic glenoid resurfacing with allograft seen as safe for joint preservation in select patients
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At the short-term to midterm follow-up, investigators found arthroscopic glenoid resurfacing with an interpositional human dermal allograft was a safe option that offered pain relief in select patients and the rate of revision to prosthetic arthroplasty was acceptable.
“Our study revealed that for patients with severe arthritis who are poor candidates for a shoulder replacement (usually young and active), an all-arthroscopic, joint-preserving surgical option exists that can provide good pain relief comparable to a total shoulder,” study co-author Robert U. Hartzler, MD, told Healio.com/Orthopedics. “With this arthroscopic interpositional arthroplasty, about three-fourths of our patients were able to avoid a shoulder replacement at average 5-year follow-up.”
Researchers performed a multicenter retrospective review of 46 shoulders in 45 patients who underwent arthroscopic glenoid resurfacing for severe glenohumeral arthritis. The minimum follow-up was 2 years or until revision. Outcome measures included pain score, American Shoulder and Elbow Surgeons score, subjective shoulder value and range of motion.
Results showed after a mean of 45 months, the revision rate to prosthetic arthroplasty was 23%. Investigators noted VAS pain score went from a median of 7 to 2. There were improvements seen in the median ASES score, active forward elevation and active external rotation.
According to researchers, the mean age of revised shoulders was higher than the age of the surviving shoulders. The revised shoulders vs. the surviving shoulders had a lower preoperative ASES score. There were no complications reported. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
Perspective
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John W. Sperling, MD, MBA
The authors report the results of arthroscopic interposition arthroplasty with human dermal allograft for the treatment of severe shoulder arthritis. The manuscript provides important information on potential risk factors for failure including older age and lower preoperative ASES scores. A technically demanding procedure, this operation may be considered in the active younger patients who wishes to pursue non-arthroplasty options. However, surgeons should be aware that the rate of revision to shoulder arthroplasty was 23% at a mean follow-up of 5 years. Longer-term data will be necessary to determine how this procedure compares against shoulder arthroplasty in the management of this challenging clinical problem.
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