Original Article
Arthroscopic Glenoid Resurfacing as a Surgical Treatment for Glenohumeral Arthritis in the Young Patient: Midterm Results

https://doi.org/10.1016/j.arthro.2009.02.018Get rights and content

Purpose

This study investigates the hypothesis that arthroscopic biologic glenoid resurfacing without humeral head replacement will provide results similar to humeral hemiarthroplasty in patients aged under 60 years.

Methods

Twenty-three consecutive patients aged 15 to 58 years (mean, 32 years) with severe glenohumeral arthritis were prospectively treated with arthroscopic resurfacing of the glenoid with a biologic patch (Restore; DePuy Orthopaedics, Warsaw, IN). Three patients left the study, leaving twenty patients to complete the study. Data collected preoperatively and postoperatively included active and passive range of motion and American Shoulder and Elbow Surgeons (ASES); Constant-Murley; Rowe; University of California, Los Angeles (UCLA); Short Form 12 (SF-12); and visual analog scale (VAS) pain scores. All patients had preoperative and postoperative imaging, either computed tomography scan (n = 2) or magnetic resonance imaging (n = 18), and were re-examined 3 to 6 years after surgery.

Results

At last follow-up, 15 patients (75%) remained satisfied. Five patients had proceeded to have surface replacement arthroplasty, but four of five said that they would undergo the arthroscopic procedure again. Active and passive range of motion improved in flexion (80° to 150°), abduction (60° to 120°), external rotation with the arm at the side (10° to 30°), external rotation in abduction (30° to 70°), and internal rotation (10° to 50°). Each rating scale used showed statistically significant (P < .05) improvement from preoperatively to postoperatively: VAS, from 8 to 2; ASES, from 22 (out of 100) to 78; UCLA, from 15 (out of 35) to 29; Rowe, from 55 (out of 100) to 81; and Constant-Murley, from 26 to 79. Six of eight parameters on the SF-12 also showed statistically significant improvements.

Conclusions

Glenoid resurfacing with the Restore patch provided statistically significant improvements for young patients with severe glenohumeral arthritis as measured by the VAS, ASES, UCLA, Rowe, Constant-Murley, and SF-12 scores at 3 to 6 years of follow-up.

Level of Evidence

Level IV, prospective case series investigating the effect of arthroscopic resurfacing rather than shoulder humeral hemiarthroplasty for grade IV arthritis of the glenohumeral joint.

Section snippets

Methods

Twenty-three patients were enrolled in the study between January 2002 and July 2004. All patients considered for the study were at the point of scheduling shoulder replacement surgery. Inclusion criteria included age less than 60 years, grade IV degenerative changes of the shoulder, failure of nonoperative measures, and a willingness to undergo the index procedure. Exclusion criteria were age greater than 60 years, anatomic insufficiency of the glenoid anatomy such that bone grafting would be

Results

All patients improved after the index operation. However, most patients did not see significant improvement until 3 to 4 months postoperatively, and they have continued to improve over the lifetime of the study. Five patients were initially successful but then deteriorated and had an additional surgery of humeral head surface replacement 1 to 5 years after the index operation, leaving an overall success rate of 75% at 3 to 6 years. Inspection of the glenoid in each of these cases showed the

Discussion

Arthroscopic management for early stages of osteoarthritis in young individuals has been shown to provide short-term pain relief even in the presence of grade IV osteochondral lesions.14 Arthroscopic procedures for arthritis include debridement and irrigation, loose body removal, chondroplasty or abrasion of the glenoid and humeral head, synovectomy, and capsular release.15 Weinstein et al.16 showed satisfactory results in 92% of patients after arthroscopic debridement. These patients had a

Conclusions

Glenoid resurfacing with the Restore patch provided statistically significant improvements for young patients with severe glenohumeral arthritis as measured by the VAS, ASES, UCLA, Rowe, Constant-Murley, and SF-12 scores at 3 to 6 years of follow-up.

Acknowledgment

The authors thank Janet Rice, Ph.D., for the analysis of data and statistical relevance.

References (21)

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The authors report no conflict of interest. Financial support was provided to Mississippi Sports Medicine by Smith & Nephew and J&J Mitek during the period of the study.

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Copyright © 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.