Biologic resurfacing of the glenoid with humeral head resurfacing for glenohumeral arthritis in the young patient

BackgroundResurfacing of the glenoid with an interposition soft tissue graft in conjunction with humeral head arthroplasty has been proposed as an option to improve glenohumeral arthritis in young patients while avoiding the potential complications associated with total shoulder arthroplasty. There currently exist minimal outcomes data for this procedure, and the results have not been consistent. The purpose of this study was to report on the outcomes in our cohort of patients aged younger than 55 years.MethodsA multicenter review of 16 patients who had undergone humeral head arthroplasty with soft tissue interposition grafting of the glenoid was performed. All patients had a minimum follow-up time of 24 months, unless revision surgery was required because of failure of the procedure.ResultsAt a mean follow-up of 60 months, the patients showed improvement in the visual analog scale score for pain from 8.1 to 5.8 (P < .05), and the American Shoulder and Elbow Surgeons score improved from 23.2 to 57.7 (P < .05). Forward elevation improved from 128° to 134° (P = .33), and external rotation improved from 28° to 32° (P = .5). Internal rotation showed no improvement. Conversion to a total shoulder arthroplasty was performed in 7 patients (44%) at a mean of 36 months.ConclusionsThe optimal management for the young patient with arthritis has not yet been established. Because of the limited improvement in patient outcomes and the relatively high revision rate, biologic resurfacing of the glenoid with humeral head resurfacing is no longer our primary treatment option for young patients and should be used with caution.