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Familiari F, Hochreiter B, Gerber C. Unacceptable failure of osteochondral glenoid allograft for biologic resurfacing of the glenoid. J Exp Orthop 2021; 8:111. [PMID: 34855012 PMCID: PMC8640012 DOI: 10.1186/s40634-021-00419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Glenohumeral osteoarthritis (OA) represents a challenging problem in young, physically active patients. It was the purpose of this investigation to evaluate the results of a pilot study involving glenoid resurfacing with a glenoid allograft combined with a hemiarthroplasty on the humeral side. Methods Between April 2011 to November 2013, 5 patients (3 men, 2 women, mean age 46.4, range 35-57) with advanced OA of the glenohumeral joint, were treated with a humeral head replacement combined with replacement of the glenoid surface with an osteochondral, glenoid allograft. Results Overall, clinically, there was one excellent, one satisfactory and three poor results. Mean preoperative subjective shoulder value (SSV) was 34% (range: 20-50%) and preoperative relative Constant-Murley-Score (CSr) was 43 points (range: 29-64 points). Three patients with poor results had to be revised within the first three years. Their mean pre-revision SSV and CSr were 38% (range: 15-80%) and 36 points (range: 7-59 points) respectively. One patient was revised 9 years after the primary procedure with advanced glenoid erosion and pain and one patient has an ongoing satisfactory outcome without revision. Their SSVs were 60% and 83%, their CSr were 65 points and 91 points, 9 and 10 years after the primary procedure, respectively. Mean follow-up was 7 years (2-10 years) and mean time to revision was 4 years (range: 1-9 years). Conclusion The in-vivo pilot study of a previously established in-vitro technique of osteochondral glenoid allograft combined with humeral HA led to three early failures and only one really satisfactory clinical outcome which, however, was associated with advanced glenoid erosion. Osteochondral allograft glenoid resurfacing was associated with an unacceptable early failure rate and no results superior to those widely documented for HA or TSA, so that the procedure has been abandoned. Level of evidence Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland. .,Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Catanzaro, Italy.
| | - Bettina Hochreiter
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
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Sowa B, Petersen M, Maier M, Bülhoff M, Bruckner T, Walch G, Raiss P. Does the degree of osteoarthritis influence the clinical outcome after anatomic total shoulder arthroplasty? Arch Orthop Trauma Surg 2020; 140:1587-1594. [PMID: 31897591 DOI: 10.1007/s00402-019-03328-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The degree of preoperative osteoarthritis has been shown to influence the postoperative outcome and the patients' satisfaction rate in hip and knee joint replacement surgery. However, no corresponding information is available for total shoulder arthroplasty (TSA). We therefore set out to evaluate the influence of preoperatively measured end-stage osteoarthritis on the postoperative clinical outcome of TSA. METHODS A retrospective analysis of 103 anatomic total shoulder replacements (96 patients) was performed. Patients were evaluated radiologically with X-rays in two planes and clinically using the Constant and Murley score (CS) and the self-reported satisfaction with the result. The degree of osteoarthritis was radiographically analyzed with the aid of the classifications according to Kellgren/Lawrence, Gerber, Guyette, and Allain and according to whether complete narrowing of the glenohumeral joint was present or not [bone-on-bone contact (BOB) or no bone-on-bone contact (No BOB)]. RESULTS The clinical results of TSA did not differ significantly among the various stages of osteoarthritis in any of the classifications (p > 0.05). The CS was significantly higher postoperatively for both the BOB and the No BOB group (p < 0.0001). Patients with BOB had a significantly lower CS preoperatively than patients with No BOB (p = 0.0172). In addition, the preoperative pain level was significantly higher in patients with BOB (p = 0.014). Postoperatively, no significant difference in CS (p = 0.6738) was found between the BOB group and the No BOB group. The mean improvement in CS was not statistically significant (p = 0.2218). CONCLUSION In contrast to hip and knee joint replacement procedures, a milder grade of osteoarthritis does not adversely influence the functional result or subjective satisfaction rate after TSA. The degree of osteoarthritis on conventional X-rays has no bearing on the postoperative clinical outcome. Therefore, the decision on when to carry out anatomic total shoulder arthroplasty should depend on the patient's pain level and loss of quality of life.
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Affiliation(s)
- Boris Sowa
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Maike Petersen
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Michael Maier
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Matthias Bülhoff
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, Universität Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz-GDS Ramsay, 24, Avenue Paul Santy, 69008, Lyon, France
| | - Patric Raiss
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. .,OCM Clinic (Orthopädische Chirurgie München), Steinerstrasse 6, 81369, Munich, Germany.
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Kaufman D, Etcheson J, Yao J. Microfracture for Ulnar Impaction Syndrome: Surgical Technique and Outcomes with Minimum 2-Year Follow-up. J Wrist Surg 2017; 6:60-64. [PMID: 28119797 PMCID: PMC5258120 DOI: 10.1055/s-0036-1586496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Purpose The purpose of this study is to assess functional and patient-reported outcomes after lunate microfracture for management of lunate chondral lesions in the setting of ulnar impaction syndrome. Methods This was a retrospective review of all patients undergoing wrist arthroscopy for triangular fibrocartilage complex pathology by one surgeon from 2007 until 2010. Disabilities of the arm, shoulder, and hand (DASH) scores were assessed preoperatively and at minimum 2-year follow-up. Patient-rated wrist evaluation and bilateral wrist range of motion, grip strength, and key pinch strength were assessed at final follow-up. Results A total of 22 patients underwent microfracture of the carpus during the study period, of which 7 met all inclusion and exclusion criteria. Mean DASH scores improved significantly (p < 0.001), from 58.3 (standard deviation: 13.5) before the procedure to 15.1 (standard deviation: 8.6) at minimum 2-year follow-up. Operative wrist pronation and supination showed equivalence with the contralateral wrist at final follow-up (p < 0.05, E = 15 degrees, standard deviation pronation: 3.25, supination: 3.49). Discussion This study suggests that lunate microfracture may be a useful technique for treating articular defects of the lunate in the setting of ulnar impaction syndrome. Type of Study/Level of Evidence Therapeutic, level IV.
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Affiliation(s)
- David Kaufman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
| | | | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
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Past and present of interposition arthroplasties for joint repair with special tribute to the contribution by Vittorio Putti. Knee Surg Sports Traumatol Arthrosc 2016; 24:4005-4011. [PMID: 25399344 DOI: 10.1007/s00167-014-3428-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
Several techniques have been proposed to restore the compromised function of a joint. These include the arthroplasty by placing various tissues or materials between the articular surfaces. An important contribution to the diffusion of arthroplasty techniques was made by Vittorio Putti, head of the Rizzoli Orthopedic Institute in Bologna from 1912 to 1940. Interposition arthroplasty is still used for some non-weight-bearing joints, such as wrist and elbow, and gives good results. This type of surgery has been further developed by the improvement in biomaterials, biomechanical studies and the regenerative medicine. This paper describes the development starting from a historical survey particularly focused on Putti's contribution and ending with the state of the art of regenerative medicine in the treatment of joint diseases. Level of evidence V.
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Garbis NG, Weber AE, Shewman EF, Cole BJ, Romeo AA, Verma NN. Glenohumeral kinematics after soft tissue interposition graft and glenoid reaming: A cadaveric study. Indian J Orthop 2016; 50:303-10. [PMID: 27293292 PMCID: PMC4885300 DOI: 10.4103/0019-5413.181789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The management of young patients with glenohumeral arthritis is controversial. Resurfacing of the glenoid with biologic interposition and reaming of the glenoid have been suggested as potential treatment options. The goal of this study was to determine the change in glenohumeral contact pressures in interposition arthroplasty, as well as glenoid reaming in an arthritis model. We hypothesized that interposition with meniscal allograft will lead to the best normalization of contact pressure throughout the glenohumeral range of motion. MATERIALS AND METHODS Eight fresh-frozen cadaveric shoulders were tested in static positions of humeral abduction with a compressive load. Glenohumeral contact area, contact pressure, and peak force were determined sequentially for (1) intact glenoid (2) glenoid with cartilage removed (arthritis model) (3) placement of lateral meniscus allograft (4) placement of Achilles allograft (5) arthritis model with reamed glenoid. RESULTS The arthritis model demonstrated statistically higher peak pressures than intact glenoid and glenoid with interpositional allograft. Meniscal and Achilles allograft lowered mean contact pressure and increased contact area to a level equal to or more favorable than the control state. In contrast, the reamed glenoid did not show any statistical difference from the arthritis model for any of the recorded measures. CONCLUSION Glenohumeral contact pressure is significantly improved with interposition of allograft at time zero compared to an arthritic state. Our findings suggest that concentric reaming did not differ from the arthritic model when compared to normal. These findings favor the use of allograft for interposition as a potential treatment option in patients with glenoid wear.
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Affiliation(s)
- Nickolas G Garbis
- Loyola University Medical Center, Maywood, USA,Address for correspondence: Dr. Nickolas G. Garbis, Loyola University Medical Center, 2160 S. First Av. Maguire Suite 1700, Maywood, IL 60153, USA. E-mail:
| | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
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Puskas GJ, Meyer DC, Lebschi JA, Gerber C. Unacceptable failure of hemiarthroplasty combined with biological glenoid resurfacing in the treatment of glenohumeral arthritis in the young. J Shoulder Elbow Surg 2015; 24:1900-7. [PMID: 26187135 DOI: 10.1016/j.jse.2015.05.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/06/2015] [Accepted: 05/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of glenohumeral osteoarthritis in young patients is challenging. Total shoulder arthroplasty reliably addresses pain and dysfunction but compromises glenoid bone stock. Various efforts have been made to avoid a prosthetic glenoid component or to prevent glenoid erosion after hemiarthroplasty. Capsular interposition, meniscal allograft, and more recently, GraftJacket (Wright Medical Technology Inc, Arlington, TN, USA), a human dermal collagen allograft, have been proposed for interposition arthroplasty in young patients with glenohumeral osteoarthritis. METHODS From 2009 to 2010, GraftJacket was used for glenoid resurfacing combined with humeral resurfacing or a stemmed hemiarthroplasty in 6 patients with a mean age of 47 years (34-57 years). Before GraftJacket was available, 5 patients were treated with a meniscal allograft and 6 with capsular interposition arthroplasty. RESULTS At a mean of 16 months (9-22 months) after the GraftJacket was implanted, 5 of the 6 patients were revised to a total shoulder arthroplasty or a reverse total shoulder arthroplasty. The sixth patient was dissatisfied but declined further surgery. The mean relative, preoperative Constant score decreased from 35% (range, 13%-61%) to 31% (range, 15%-43%) at revision or latest follow-up. Of the 5 patients with meniscal allograft, 3 underwent revision at a mean of 22 months (range, 12-40 months), and 4 of the 6 patients with capsular interposition were revised at a mean of 34 months (range, 23-45 months). The mean relative Constant scores preoperatively and at revision or latest follow-up were 44% (range, 19%-68%) and 58% (range, 9%-96%) for the meniscal allograft patients and 47% (range, 38%-62%) and 63% (range, 32%-92%) for the capsular interposition cases. CONCLUSION In our hands, 3 different types of biological resurfacings combined with humeral hemiarthroplasty have an unacceptable early failure rate.
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Affiliation(s)
- Gabor J Puskas
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Dominik C Meyer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Julia A Lebschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
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Bois AJ, Whitney IJ, Somerson JS, Wirth MA. Humeral Head Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid: A Concise Follow-up of a Previous Report and Survivorship Analysis. J Bone Joint Surg Am 2015; 97:1571-7. [PMID: 26446964 DOI: 10.2106/jbjs.n.01079] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The two to five-year results of humeral head arthroplasty and lateral meniscal allograft resurfacing of the glenoid in patients fifty-five years of age or younger were previously reported by the senior author (M.A.W.). The purpose of the present study was to report the survival rate, clinical findings, and radiographic results of the original thirty shoulders (thirty patients) followed for a mean duration of 8.3 years (range, five to twelve years). The scores on the visual analog scale for pain, American Shoulder and Elbow Surgeons scoring system, and Simple Shoulder Test were significantly improved at the latest follow-up evaluation compared with the preoperative findings (p < 0.001). Radiographic indices of posterior subluxation did not significantly increase from the immediate postoperative imaging to the latest radiographs, while the glenohumeral joint space demonstrated a gradual decrease. Nine (30%) of thirty shoulders were known to have undergone a reoperation. The present study demonstrated that biological glenoid resurfacing combined with hemiarthroplasty can provide significant improvement in shoulder function and pain relief in young patients with glenohumeral arthritis; however, mid-term follow-up at a mean of over eight years demonstrated a high reoperation rate.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB T2N 4N1, Canada. E-mail address:
| | - Ian J Whitney
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Jeremy S Somerson
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Michael A Wirth
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
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Acevedo DC, Shore B, Mirzayan R. Orthopedic applications of acellular human dermal allograft for shoulder and elbow surgery. Orthop Clin North Am 2015; 46:377-88, x. [PMID: 26043051 DOI: 10.1016/j.ocl.2015.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Shoulder and elbow tendon injuries are some of the most challenging problems to treat surgically. Tendon repairs in the upper extremity can be complicated by poor tendon quality and, often times, poor healing. Extracellular matrices, such as human dermal allografts, have been used to augment tendon repairs in shoulder and elbow surgery. The indications and surgical techniques regarding the use of human dermal allograft continue to evolve. This article reviews the basic science, rationale for use, and surgical applications of human dermal allograft in shoulder and elbow tendon injuries.
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Affiliation(s)
- Daniel C Acevedo
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA.
| | - Brett Shore
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA
| | - Raffy Mirzayan
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA
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Millett PJ, Euler SA, Dornan GJ, Smith SD, Collins T, Michalski MP, Spiegl UJ, Jansson KS, Wijdicks CA. The ability of massive osteochondral allografts from the medial tibial plateau to reproduce normal joint contact pressures after glenoid resurfacing: the effect of computed tomography matching. J Shoulder Elbow Surg 2015; 24:e125-34. [PMID: 25457785 DOI: 10.1016/j.jse.2014.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current techniques for resurfacing of the glenoid in the treatment of arthritis are unpredictable. Computed tomography (CT) studies have demonstrated that the medial tibial plateau has close similarity to the glenoid. The purpose of this study was to assess contact pressures of transplanted massive tibial osteochondral allografts to resurface the glenoid without and with CT matching. METHODS Ten unmatched cadaveric tibiae were used to resurface 10 cadaveric glenoids with osteochondral allografts. Five cadaveric tibiae and glenoids were CT matched and studied. An internal control group of 4 matched pairs of glenoids, with the contralateral glenoid transplanted to the opposite glenoid, was also included as a best-case scenario to measure the effects of the surgical technique. All glenoids were tested before and after grafting at different abduction and rotation angles, with recording of peak contact pressures. RESULTS Peak contact pressures were not different from the intact state in the autografted group but were increased in both allografted groups. CT-matched tibial grafts had lower peak pressures than unmatched grafts. Peak pressures were on average 24.8% (range [18.3%, 29.6%]) greater than in the native glenoids for unmatched allografts, 21.8% ([17.0%, 25.5%]) greater for the matched allografts, and 4.9% ([3.8%, 5.5%]) greater for matched autografts. CONCLUSION Osteochondral grafting from the medial tibial plateau to the glenoid is feasible but results in increased peak contact pressures. The technique is reproducible as defined by the autografted group. Contact pressures between native and allografted glenoids were significantly different. The clinical significance remains unknown. Peak pressures experienced by the glenoid seem highly sensitive to deviations from the native glenoid shape.
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Affiliation(s)
- Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Simon A Euler
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Innsbruck, Austria.
| | | | - Sean D Smith
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Tyler Collins
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - Ulrich J Spiegl
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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Muh SJ, Streit JJ, Shishani Y, Dubrow S, Nowinski RJ, Gobezie R. Biologic resurfacing of the glenoid with humeral head resurfacing for glenohumeral arthritis in the young patient. J Shoulder Elbow Surg 2014; 23:e185-90. [PMID: 24439248 DOI: 10.1016/j.jse.2013.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/30/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Resurfacing 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. METHODS A 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. RESULTS At 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. CONCLUSIONS The 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.
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Affiliation(s)
- Stephanie J Muh
- Department of Orthopaedics, Henry Ford Health Systems, Detroit, MI, USA
| | - Jonathan J Streit
- Department of Orthopaedics, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Yousef Shishani
- Cleveland Shoulder Institute, University Hospitals of Cleveland, Mayfield Heights, OH, USA
| | - Samuel Dubrow
- Cleveland Shoulder Institute, University Hospitals of Cleveland, Mayfield Heights, OH, USA
| | | | - Reuben Gobezie
- Cleveland Shoulder Institute, University Hospitals of Cleveland, Mayfield Heights, OH, USA.
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Venkatachalam S, Nicolas AP, Liow R. Treatment of chronic anterior locked glenohumeral dislocation with hemiarthroplasty. Shoulder Elbow 2014; 6:100-4. [PMID: 27582922 PMCID: PMC4935069 DOI: 10.1177/1758573213518498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/06/2013] [Indexed: 11/16/2022]
Abstract
Restoring good shoulder function in an active patient with a chronic anterior locked dislocation of the glenohumeral joint can be challenging. This case report describes a 58-year-old active patient who presented with a very late missed locked anterior dislocation of the glenohumeral joint. He had coexisting large bony defects in the anterior glenoid and humeral head with resultant loss of motion and pain secondary to glenohumeral arthrosis. He underwent a humeral hemiarthroplasty, glenoid structural bone grafting, glenoid biological resurfacing and reinforcement of anterior capsule with the graft jacket to achieve a pain-free, stable, mobile joint with good range of movements and function. The clinical decision-making process and the surgical technique used in the management of this difficult condition are discussed.
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Affiliation(s)
- Santosh Venkatachalam
- Santosh Venkatachalam, Friarage Hospital, Northallerton, North Yorkshire, DL6 1JG, UK. Tel.: +44 (0)1609 762526. Fax: +44 (0)1609 771126. E-mail:
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12
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Strauss EJ, Verma NN, Salata MJ, McGill KC, Klifto C, Nicholson GP, Cole BJ, Romeo AA. The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis. J Shoulder Elbow Surg 2014; 23:409-19. [PMID: 24012358 DOI: 10.1016/j.jse.2013.06.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 05/20/2013] [Accepted: 06/01/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The current study evaluated the outcomes of biologic resurfacing of the glenoid using a lateral meniscus allograft or human acellular dermal tissue matrix at intermediate-term follow-up. METHODS Forty-five patients (mean age, 42.2 years) underwent biologic resurfacing of the glenoid, and 41 were available for follow-up at a mean of 2.8 years. Lateral meniscal allograft resurfacing was used in 31 patients and human acellular dermal tissue matrix interposition in 10. Postoperative range of motion and clinical outcomes were assessed at the final follow-up. RESULTS The overall clinical failure rate was 51.2%. The lateral meniscal allograft cohort had a failure rate of 45.2%, with a mean time to failure of 3.4 years. Human acellular dermal tissue matrix interposition had a failure rate of 70.0%, with a mean time to failure of 2.2 years. Overall, significant improvements were seen compared with baseline with respect to the visual analog pain score (3.0 vs. 6.3), American Shoulder and Elbow Surgeons score (62.0 vs. 36.8), and Simple Shoulder Test score (7.0 vs. 4.0). Significant improvements were seen for forward elevation (106° to 138°) and external rotation (31° to 51°). CONCLUSION Despite significant improvements compared with baseline values, biologic resurfacing of the glenoid resulted in a high rate of clinical failure at intermediate follow-up. Our results suggest that biologic resurfacing of the glenoid may have a minimal and as yet undefined role in the management of glenohumeral arthritis in the young active patient over more traditional methods of hemiarthroplasty or total shoulder arthroplasty.
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Affiliation(s)
- Eric J Strauss
- New York University Hospital for Joint Diseases, New York, NY, USA.
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | | | - Kevin C McGill
- New York University Hospital for Joint Diseases, New York, NY, USA
| | | | | | - Brian J Cole
- New York University Hospital for Joint Diseases, New York, NY, USA
| | - Anthony A Romeo
- New York University Hospital for Joint Diseases, New York, NY, USA
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Abstract
CONTEXT The mature athlete's shoulder remains a challenging clinical condition to manage. A normal natural history of the shoulder includes stiffness, rotator cuff tears, and osteoarthritis, all of which can become increasingly more symptomatic as an athlete ages. EVIDENCE ACQUISITION PubMed (1978-2013). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3-4. RESULTS Rotator cuff pathology increases with age and activity level. Partial tears rarely heal, and debridement of significant partial tears results in poorer outcomes than those of repair. Repair of partial-thickness tears can be accomplished with completion and subsequent repair or in situ repair. The most successful result for treatment of osteoarthritis in the shoulder remains total shoulder arthroplasty, with more than 80% survival at 20 years and high rates of return to sport. Caution should be taken in patients younger than 60 years, as they show much worse results with this treatment. Adhesive capsulitis of the shoulder can be successfully treated with nonoperative management in 90% of cases. CONCLUSION Mature athletes tend to have rotator cuff pathology, osteoarthritis, and stiffness, which may limit their participation in athletic events. Age is a significant consideration, even within the "mature athlete" population, as patients younger than 50 years should be approached differently than those older than 65 years with regard to treatment regimens and postoperative restriction.
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Hammond LCDRJ, Lin EC, Harwood DP, Juhan TW, Gochanour E, Klosterman EL, Cole BJ, Nicholson GP, Verma NN, Romeo AA. Clinical outcomes of hemiarthroplasty and biological resurfacing in patients aged younger than 50 years. J Shoulder Elbow Surg 2013; 22:1345-51. [PMID: 23796385 DOI: 10.1016/j.jse.2013.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 03/23/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty as a treatment for glenohumeral degenerative joint disease is well accepted but has been less predictable with regard to outcomes and durability in a younger aged population, typically aged younger than 50 years. This younger population has a greater potential for glenoid component loosening. This has led surgeons to perform hemiarthroplasty or hemiarthroplasty with biological resurfacing of the glenoid in an effort to avoid the potential problems with a polyethylene glenoid and obtain durable and acceptable results for these patients. METHODS The study included 44 patients, with 23 undergoing hemiarthroplasty alone and 21 undergoing hemiarthroplasty with biological resurfacing of the glenoid. All patients were aged younger than 50 years. Preoperative diagnoses, comorbidities, demographics, and range of motion were collected. Preoperative and postoperative radiographs were obtained. Preoperative and postoperative objective scoring measures (Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons score, visual analog scale, Simple Shoulder Test, Constant-Murley) were used. RESULTS Mean follow-up was 3.8 years for the hemiarthroplasty group and 3.6 years for the biological resurfacing group. Six patients in the hemiarthroplasty and 12 patients in the biological resurfacing group were considered failures due to revision surgery or an American Shoulder and Elbow Surgeons score <50. The hemiarthroplasty group had significantly better visual analog scale and Single Assessment Numeric Evaluation scores. CONCLUSIONS There was a significant failure rate in the hemiarthroplasty and the biologic resurfacing groups compared with results in the literature. Improved outcomes and lower failure rates were observed in the hemiarthroplasty group compared with the biological resurfacing group in this study.
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Affiliation(s)
- L C D R James Hammond
- Division of Sports Medicine, Department of Orthopaedics, Naval Medical Center Portsmouth, Portsmouth, VA, USA
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Widnall JC, Dheerendra SK, Macfarlane RJ, Waseem M. The use of shoulder hemiarthroplasty and humeral head resurfacing: a review of current concepts. Open Orthop J 2013; 7:334-7. [PMID: 24082971 PMCID: PMC3785053 DOI: 10.2174/1874325001307010334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/17/2012] [Accepted: 11/24/2012] [Indexed: 12/27/2022] Open
Abstract
Since Neer's early work in the 1950s shoulder arthroplasty has evolved as a treatment option for various glenohumeral joint disorders. Both hemiarthroplasty and total shoulder prostheses have associated problems. This has led to further work with regards to potential resurfacing, with the aim of accurately restoring native proximal humeral anatomy while preserving bone stock for later procedures if required. Hemiarthroplasty remains a valuable treatment option in the low demand patient or in the trauma setting. Additional work is required to further define the role of humeral resurfacing, with the potential for it to become the gold standard for younger patients with isolated humeral head arthritis.
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Affiliation(s)
- James C Widnall
- Department of Trauma & Orthopaedics, Aintree University Hospital NHS Foundation Trust, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
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Namdari S, Melnic C, Huffman GR. Foreign body reaction to acellular dermal matrix allograft in biologic glenoid resurfacing. Clin Orthop Relat Res 2013; 471:2455-8. [PMID: 23479235 PMCID: PMC3705065 DOI: 10.1007/s11999-013-2904-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 02/27/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biologic glenoid resurfacing is a treatment option for young patients with glenohumeral arthritis. An optimal synthetic graft for glenoid resurfacing should allow repopulation with host cells, be durable enough to tolerate suture fixation and forces across the joint, and present no host inflammatory response. We report two cases of giant cell reaction to GraftJacket(®) after biologic glenoid resurfacing. CASE DESCRIPTION Two patients who underwent hemiarthroplasty and biologic glenoid resurfacing using GraftJacket(®) had a foreign body giant cell reaction that required revision surgery. Intraoperatively, both patients were observed to have a well-fixed humeral component and a dense, erythematous, synovitic membrane overlying the glenoid. Pathology specimens showed a benign reactive synovium, chronic inflammation, and foreign body giant cell reaction. After débridement and conversion to total shoulder arthroplasty, both patients continued to be pain-free at greater than 1-year followup. LITERATURE REVIEW Multinucleated giant cell and mononuclear cell responses have been observed in an animal model after use of GraftJacket(®). Although the use of acellular matrix-based scaffold for biologic glenoid resurfacing is not new, the possibility of foreign body reaction as a source of persistent symptoms has not been described. CLINICAL RELEVANCE Given the lack of data to indicate an advantage to biologic resurfacing of the glenoid over hemiarthroplasty alone, resurfacing should not introduce significant additional surgical complications. We suggest foreign body reaction be considered in the differential diagnosis for a persistently painful shoulder after biologic glenoid resurfacing using an acellular allograft patch.
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Affiliation(s)
- Surena Namdari
- Department of Orthopedic Surgery, Washington University, St Louis, MO 63110 USA
| | - Christopher Melnic
- Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - G. Russell Huffman
- Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, 1 Cupp Pavilion, 3900 Market Street, Philadelphia, PA 19104 USA
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Lee BK, Vaishnav S, Rick Hatch GF, Itamura JM. Biologic resurfacing of the glenoid with meniscal allograft: long-term results with minimum 2-year follow-up. J Shoulder Elbow Surg 2013; 22:253-60. [PMID: 22929583 DOI: 10.1016/j.jse.2012.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/10/2012] [Accepted: 04/22/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a lack of consensus in treating glenohumeral arthritis in younger patients. Hemiarthroplasty has historically been favored because of complications associated with total shoulder arthroplasty. Biologic resurfacing of the glenoid has been investigated as a potential treatment that would decrease glenoid erosion and pain, the major complications of hemiarthroplasty. MATERIALS AND METHODS We report on 19 shoulders treated with meniscal allograft glenoid resurfacing and shoulder hemiarthroplasty. All patients were followed up for a minimum of 2 years postoperatively (mean, 4.25 years) with Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test (SST), and visual analog scale (VAS) scores. In addition, we compared the outcomes related to preoperative concentric versus eccentric glenoid wear. RESULTS At final follow-up, the mean score for the DASH questionnaire was 28; SST, 8; and VAS, 3.5. Whereas the eccentric wear group (DASH score, 19.4; SST score, 9.1; VAS score, 2.5) exhibited better shoulder function and pain scores compared with the concentric wear group (DASH score, 37.6; SST score, 8.4; VAS score, 4.1), the difference was not statistically significant (P = .098, P = .647, and P = .198, respectively). There were 6 complications (32%), all resulting in repeat surgery. Three patients underwent total shoulder arthroplasty and one shoulder had revision hemiarthroplasty, whereas synovectomy was performed in another shoulder. The sixth patient underwent lysis of adhesions and capsular release. DISCUSSION With long-term follow-up, we have observed that biologic resurfacing of the glenoid with meniscal allograft exhibits inconsistent results and high complication rates. Strong consideration should be given to performing total shoulder arthroplasty in patients in whom all conservative treatment options have failed.
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Affiliation(s)
- Brian K Lee
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Killian ML, Cavinatto L, Galatz LM, Thomopoulos S. Recent advances in shoulder research. Arthritis Res Ther 2012; 14:214. [PMID: 22709417 PMCID: PMC3446497 DOI: 10.1186/ar3846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.
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Affiliation(s)
- Megan L Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, USA
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Joseph RM, Barhorst J. Surgical reconstruction and mobilization therapy for a retracted extensor hallucis longus laceration and tendon defect repaired by split extensor hallucis longus tendon lengthening and dermal scaffold augmentation. J Foot Ankle Surg 2012; 51:509-16. [PMID: 22658790 DOI: 10.1053/j.jfas.2012.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Indexed: 02/03/2023]
Abstract
A reconstructive technique and physical therapy protocol is presented for the treatment of extensor hallucis longus (EHL) lacerations with critical size defects caused by tendon retraction. The primary goal of treatment was to restore EHL structure and function without the use of a bridging allograft or tendon transfer. The technique is performed by split lengthening the distal segment of the lacerated EHL and rotating the lengthened segment proximally 180° to bridge the tendon defect. The lengthened tendon is then sutured to the proximal segment of the EHL. The EHL is then tubularized with an acellular dermal scaffold at the region of tendon rotation to improve tendon strength, minimize the probability of tendon overlengthening or re-rupture, and improve the tendon gliding motion, which can be compromised by the tendon irregularity caused by rotation of the tendon. Postoperative range of motion therapy should be initiated at 3 weeks postoperatively. A case report of this technique and postoperative mobilization protocol is presented. The American Orthopaedic Foot and Ankle Society midfoot score at 3 and 6 months postoperatively was 90 of 100. The patient regained active dorsiflexion motion of the hallux without functional limitations, deformity, or contracture of the hallux. The advantages of this technique include that a large cadaveric allograft is not needed to bridge a critical size tendon defect and tendon lengthening provides a biologically active tendon graft without the secondary comorbidities and dysfunction commonly associated with tendon transfer procedures.
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Affiliation(s)
- Robert M Joseph
- Perspective Advantage Solutions, LLC, Dayton, OH 45409, USA.
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Abstract
Young patients with degenerative shoulder disease are a therapeutic challenge. To try to delay a shoulder arthroplasty, biological interpositional arthroplasty has been proposed to provide a biologically active bearing surface that could eventually results in the formation of fibrocartilage, fibrous tissue, or hyaline cartilage. Anterior capsule, autogenous fascia lata, Achilles tendon allograft, lateral meniscus allograft, human dermis, and porcine small intestine submucosa have been used as interposition material, either alone or in combination with a hemiarthroplasty or humeral resurfacing procedure. Some investigators have reported favorable long-term results, although others have found this procedure unreliable. Several variables are unknown at present, such as the best biological resurfacing device, healing potential, possible antigenic responses, optimal fixation technique or position, aftercare restrictions. Further prospective studies with long follow-up are necessary to provide data that will help to define the role of biological glenoid resurfacing in young patients with glenohumeral arthritis.
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Abstract
Management of glenohumeral arthrosis with a total shoulder prosthesis is becoming increasingly common. However, failure of the glenoid component remains one of the most common causes for failure. Our understanding of this problem has evolved greatly since the first implants were placed in the 1970's. However glenoid failure remains a challenging problem to address and manage. This article reviews the current knowledge regarding the glenoid in total shoulder arthroplasty touching on anatomy, component design, implant fixation, causes of implant failure, management of glenoid failure and alternatives to glenoid replacement.
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Namdari S, Alosh H, Baldwin K, Glaser D, Kelly JD. Biological glenoid resurfacing for glenohumeral osteoarthritis: a systematic review. J Shoulder Elbow Surg 2011; 20:1184-90. [PMID: 21803608 DOI: 10.1016/j.jse.2011.04.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/08/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Surena Namdari
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, PA, USA.
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Namdari S, Goel DP, Romanowski J, Glaser D, Warner JJP. Principles of glenoid component design and strategies for managing glenoid bone loss in revision shoulder arthroplasty in the absence of infection and rotator cuff tear. J Shoulder Elbow Surg 2011; 20:1016-24. [PMID: 21705237 DOI: 10.1016/j.jse.2011.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/12/2011] [Accepted: 03/27/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Surena Namdari
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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25
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Glenohumeral arthritis in the young patient. J Shoulder Elbow Surg 2011; 20:S30-40. [PMID: 21281920 DOI: 10.1016/j.jse.2010.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 02/01/2023]
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Abstract
The successful diagnosis and treatment of glenohumeral arthrosis in the young and active patient can be challenging to even the most experienced of clinicians. A thorough preoperative evaluation, including a detailed understanding of patient expectations, facilitates the selection of a treatment strategy. Arthroscopy is the gold standard for detecting chondral injuries, and it is increasingly used as an effective first line of management. In patients who fail arthroscopic debridement and reparative techniques, further treatment should proceed with an algorithmic decision-making approach encompassing patient-based and disease-based factors. Restorative and reconstructive techniques may provide improvements in pain and functional outcome while delaying the need for total shoulder arthroplasty, although the longevity of these treatments has yet to be established in the literature. Hemiarthroplasty and total shoulder arthroplasty have historically proven to be the most durable and reliable options in properly selected patients. However, concerns about progressive glenoid erosion and glenoid component loosening have led many to pursue alternative nonarthroplasty techniques for the management of arthrosis in active young individuals.
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Affiliation(s)
- Karen J Boselli
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, New York, USA
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27
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Walch G, Boileau P, Noël E. Shoulder arthroplasty: Evolving techniques and indications. Joint Bone Spine 2010; 77:501-5. [DOI: 10.1016/j.jbspin.2010.09.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2010] [Indexed: 11/30/2022]
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Ohl X, Nérot C, Saddiki R, Dehoux E. Shoulder hemi arthroplasty radiological and clinical outcomes at more than two years follow-up. Orthop Traumatol Surg Res 2010; 96:208-15. [PMID: 20488137 DOI: 10.1016/j.otsr.2010.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 11/06/2009] [Accepted: 01/07/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Humeral head replacement is used for glenohumeral osteoarthritis in young or active patients, for conditions sparing glenoid cartilage or when glenoid implantation does not appear feasible. These surgical procedures usually give satisfactory results but there is a risk of glenoid erosion and a possible deterioration of long-term outcomes. HYPOTHESIS There is a risk of glenoid erosion after humeral head replacement which can be radiographically measured. The importance and progression of this erosion should be evaluated to determine its clinical relevance. PATIENT AND METHODS This is a retrospective study in 15 patients (19 shoulders) who underwent humeral head replacement between 1999 and 2006. There were 11 women and four men with an average age of 54.5 years. Etiologies were avascular necrosis (11 cases) and glenohumeral osteoarthritis (eight cases). All patients were reviewed in 2008 with more than two years follow-up. Clinical evaluation included measurements of range of motion and determination of the Constant and Murley score. In addition, the patients were asked to provide a subjective evaluation of their shoulder. Radiographic analysis included computer-assisted measurements. RESULTS The average follow-up was 45.8 months (26-108). At one year postoperative and at the final follow-up, clinical parameters such as the Constant and Murley score (37.4/100 preoperative to 64.4/100 at final follow-up) were significantly increased. During the first year, the rate of glenoid wear was 1.03 mm/year in case of avascular necrosis and 0.27 mm/year in case of osteoarthritis (p<0.001). Glenoid depth at the final follow-up was 6.97 mm for osteoarthritis compared to 4.59 mm for avascular necrosis (p<0.01). We did not find any correlation between glenoid erosion severity and clinical results. DISCUSSION Isolated humeral head replacement may result in glenoid erosion. The rate of progression of this erosion is clearly influenced by the etiology and therefore by the preexisting condition of the glenoid cartilage. At the average follow-up, the radiological glenoid deterioration is not correlated with pain or deterioration of clinical results. LEVEL OF EVIDENCE Level IV. Therapeutic study.
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Affiliation(s)
- X Ohl
- Maison Blanche Teaching Hospital Center, Department of Orthopaedic Surgery and traumatology, 45, rue Cognacq-Jay, 51100 Reims, France.
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30
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Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty. J Shoulder Elbow Surg 2010; 19:325-34. [PMID: 20303459 DOI: 10.1016/j.jse.2009.11.057] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 11/18/2009] [Accepted: 11/22/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. METHODS A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. RESULTS In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. CONCLUSION Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective.
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31
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Biologic resurfacing of the ankle and first metatarsophalangeal joint: case studies with a 2-year follow-up. Clin Podiatr Med Surg 2009; 26:633-45. [PMID: 19778693 DOI: 10.1016/j.cpm.2009.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The goal of biologic resurfacing is to provide a smooth joint surface with a low coefficient of friction, which allows the joint to function with near normal biomechanics, as well as provide intermittent pressure, to the subchondral and cancellous bone. This unique combination often results in the formation of a "neocartilage-like" structure that can reduce pain and restore biomechanics. As well as giving a brief history of cutis arthroplasty, this article describes cases in which the ankle and first metatarsophalangeal joint underwent biologic resurfacing, with a 2-year postoperative follow up.
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Strauss EJ, Roche C, Flurin PH, Wright T, Zuckerman JD. The glenoid in shoulder arthroplasty. J Shoulder Elbow Surg 2009; 18:819-33. [PMID: 19574062 DOI: 10.1016/j.jse.2009.05.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/02/2009] [Accepted: 05/04/2009] [Indexed: 02/01/2023]
Abstract
Total shoulder arthroplasty is a common treatment for glenohumeral arthritis. One of the most common failure modes of total shoulder arthroplasty is glenoid loosening, causing postoperative pain, limitation of function, and potentially, the need for revision surgery. The literature has devoted considerable attention to the design of the glenoid component; efforts to better understand the biomechanics of the reconstructed glenohumeral joint and identify factors that contribute to glenoid component loosening are ongoing. This article reviews the current state of knowledge about the glenoid in total shoulder arthroplasty, summarizing the anatomic parameters of the intact glenoid, variations in component design and fixation, the mechanisms of glenoid loosening, the outcomes of revision surgery in the treatment of glenoid component failure, and alternative treatments for younger patients.
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Affiliation(s)
- Eric J Strauss
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY 10003, USA
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34
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Trapezium resection with suspension and interposition arthroplasty using acellular dermal allograft for thumb carpometacarpal arthritis. J Hand Surg Am 2009; 34:1029-36. [PMID: 19500916 DOI: 10.1016/j.jhsa.2009.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 02/27/2009] [Accepted: 03/03/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Trapezium excision with ligament reconstruction and tendon interposition has proved to be highly effective in the treatment of thumb carpometacarpal joint arthritis. Donor-site morbidity from autograft harvest can be avoided by using an allograft. We report the outcomes after suspension and interposition arthroplasty using an acellular dermal allograft (GraftJacket; Wright Medical Technology, Inc., Arlington, TN) for thumb carpometacarpal arthritis. METHODS Eighty-nine patients (100 thumbs) had surgery for thumb carpometacarpal arthritis using acellular dermal allograft instead of flexor carpi radialis tendon autograft. Evaluation of the results was performed for 82 thumbs with adequate data. Each patient was followed up for a minimum of 12 months (average, 30 months). Pain levels, grip strength, key pinch strength, range of motion, and radiographic measurements were performed. RESULTS Between the preoperative and final follow-up measurements, patient pain levels (on a visual analog scale) were significantly reduced, from 6.2 to 0.7. Comparisons between preoperative and postoperative strength measurements showed an average 16% increase in grip strength and 19% increase in key pinch strength. No differences were found for radial abduction and palmar abduction data, respectively. Comparison with the preoperative x-rays showed the thumb metacarpal had subsided 31% of the arthroplasty space. No patient experienced a foreign body reaction or suffered an infection in our series. CONCLUSIONS Trapeziectomy with suspension and interposition arthroplasty using an acellular dermal allograft is highly effective for the treatment of thumb carpometacarpal arthritis. This procedure provides a safe and effective alternative to autograft for both ligament reconstruction and tendon interposition and eliminates the potential morbidity of autograft harvest. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Lee DK. Ankle arthroplasty alternatives with allograft and external fixation: preliminary clinical outcome. J Foot Ankle Surg 2008; 47:447-52. [PMID: 18725126 DOI: 10.1053/j.jfas.2008.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED Tibiotalar joint reconstruction for the treatment of osteoarthritic and post-traumatic arthritic joint remains controversial and unsatisfactory. While the current literature recommends joint arthrodesis as a gold standard, current developments in allograft technology may aid in the repair of articular damage; avoid any metallic implant wear, failure, and revision; and preserve normal musculoskeletal biomechanics. The purpose of this retrospective study was to report the early clinical outcomes of ankle arthroplasty with allograft and with the application of a monolateral external fixation in the treatment of ankle arthritis. Eighteen patients (18 ankles, n = 18) with end-stage ankle arthritis, underwent surgical intervention. The mean preoperative AOFAS score was 32.0 +/- 1.1 (30-33) while the postop was 87.33 +/- 7.6 (81-97) (P = .000). There were no complications associated with the allograft material. There were also no complications with the external fixator. The early clinical outcome results provided an optimistic view of this procedure as another alternative treatment for the arthritic ankle, with subjective patient improvement and satisfaction, as well as a statistically significant and functionally increased range of motion and joint space and objective improvements. Allograft implantation with external fixation for the arthritic tibiotalar joint provided encouraging preliminary results and patient satisfaction mirroring current outcomes from shoulder and animal studies. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Daniel K Lee
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA 92103-8894, USA.
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Raiss P, Aldinger PR, Kasten P, Rickert M, Loew M. Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis. ACTA ACUST UNITED AC 2008; 90:764-9. [DOI: 10.1302/0301-620x.90b6.20387] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the supraspinatus tendon occurred. Overall, 20 patients (95%) were either very satisfied (n = 18) or satisfied (n = 2) with the outcome. Significant differences (p < 0.0001) were found for all categories of the Constant and Murley score pre- and post-operatively. The mean Constant and Murley score increased from 24.1 points (10 to 45) to 64.5 points (39 to 93), and the relative score from 30.4% (11% to 50%) to 83% (54% to 116%). No clinical or radiological signs of loosening of the implant were seen. For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term.
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Affiliation(s)
- P. Raiss
- Department of Shoulder and Elbow Surgery, Orthopaedic University Hospital of Heidelberg, Schlierbacher, Landstrasse, 200a, 69118 Heidelberg, Germany
| | - P. R. Aldinger
- Department of Shoulder and Elbow Surgery, Orthopaedic University Hospital of Heidelberg, Schlierbacher, Landstrasse, 200a, 69118 Heidelberg, Germany
| | - P. Kasten
- Department of Shoulder and Elbow Surgery, Orthopaedic University Hospital of Heidelberg, Schlierbacher, Landstrasse, 200a, 69118 Heidelberg, Germany
| | - M. Rickert
- Department of Shoulder and Elbow Surgery, Orthopaedic University Hospital of Heidelberg, Schlierbacher, Landstrasse, 200a, 69118 Heidelberg, Germany
| | - M. Loew
- Department of Shoulder and Elbow Surgery, Orthopaedic University Hospital of Heidelberg, Schlierbacher, Landstrasse, 200a, 69118 Heidelberg, Germany
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Humeral resurfacing hemiarthroplasty with meniscal allograft in a young patient with glenohumeral osteoarthritis. J Orthop Sports Phys Ther 2008; 38:277-86. [PMID: 18448881 DOI: 10.2519/jospt.2008.2546] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Management of glenohumeral joint osteoarthritis in young, active patients is challenging due to the significant functional limitations and progression of the disease, coupled with the limited lifespan of prosthetic implants presently in use. The purpose of this report is to present the detailed rehabilitation program and outcome of a patient who suffered an initial glenohumeral dislocation and, following multiple surgical interventions, required shoulder hemiarthroplasty and biologic glenoid resurfacing to return to function. CASE DESCRIPTION An objectively based rehabilitation protocol was used for this patient following shoulder hemiarthroplasty. Data collected included passive and active range of motion, isometric rotational strength, and functional outcome scores to include the Single Assessment Numeric Evaluation (SANE) and American Shoulder Elbow Surgeons (ASES) outcome measures. OUTCOMES Progressive improvements in active and passive range of motion were documented at numerous points during postoperative rehabilitation, including 1 and 2 years postoperatively. The patient's initial functional outcome scores improved from 2/100 to 90/100 in the SANE and from 17/100 to 85/100 for the ASES rating scales. At 2 years postsurgery the SANE score was 60/100 and ASES 68/100. DISCUSSION Early postoperative range of motion exercises performed in a range protecting the subscapularis, coupled with a progressive program of rotator cuff and scapular strengthening exercises, resulted in decreased pain, improved range of motion, and return to work in a limited capacity following hemiarthroplasty with biologic glenoid resurfacing. Further research in series of patients following this procedure will help to establish optimal treatment guidelines and prognosis for young active patients with severe glenohumeral joint osteoarthritis. LEVEL OF EVIDENCE Therapy, level 4.
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