This study evaluated the short-term clinical and radiographic outcomes of 64 patients who underwent biological resurfacing of the glenoid with a dermal graft and humeral head resurfacing. At a minimum of 2 years follow-up, patients demonstrated improvements in pain, range of motion, and function based on standardized scores. Radiographically, the procedure improved glenoid version and centering of the humeral head in patients with preoperative subluxation. One patient required revision to a polyethylene glenoid. The authors concluded that biological resurfacing may be a viable alternative to polyethylene resurfacing in young, active patients with glenohumeral osteoarthritis.

1. Methods
• Prospective, non-randomized study. Surgical technique: 64
patients underwent biological resurfacing total shoulder
replacement with human dermal graft to resurface the glenoid and
a humeral head resurfacing prosthesis.
Glenoid version correction and recontouring was performed
with a burr with attention to preserving the labrum. A
motorized reamer was not used.
• Inclusion criteria: Complete baseline scores, minimum 24 month
follow-up
• Radiographic Review: Pre-operative and final postoperative
anteroposterior and axillary radiographs were evaluated for
subluxation and retroversion using the methods described by
Walch 5. Glenoid morphology was determined using the Walch
classification.
Short Term Outcomes After Biologic Resurfacing Shoulder Arthroplasty For The Young and/or Active Patient
B. Sears(3B- Shoulder Options) T.K. Hawkes (n), A. Hatzidakis (2, 3B, 4, 5- Tornier; 5- Baxter)
Western Orthopaedics
1.A 1.B
Introduction
Total shoulder arthroplasty with a polyethylene glenoid component
in the young and active population presents a challenging problem:
Younger patients have a higher activity level with both work
and extracurricular activities 3
. 1
A higher and more demanding use of the shoulder likely
increases strain and ultimately polyethylene wear with early
glenoid loosening 4.
Biologic resurfacing of the glenoid is an alternative treatment
for younger patients, but techniques reported in the literature
have been variable and clinical results inconsistent 1,2,4.
Purpose: To assess the short to intermediate –term clinical and
radiologic outcomes following biologic resurfacing of the glenoid
coupled with stemless resurfacing of the humeral head, utilizing a
standardized technique.
Hypothesis: Patients will show comparable or improved clinical
outcomes to those reported in literature. The surgical technique will
demonstrate improved centering of the humeral head in patients
with preoperative B2 glenoid morphology.
Results (Continued)
• One patient had persistent pain requiring revision to a total
shoulder arthroplasty with polyethylene glenoid resurfacing at 16
months following surgery (1/44 [2%]).
• 93% (41/44) of the cohort were very satisfied or satisfied with
their shoulder. 7% (3/44) were dissatisfied.
• Pre-operative Glenoid morphology: Of the 39 patients available
for radiographic review at a minimum of 2 years, 6 had a type A1, 5
had an A2, 5 had a B1, 22 had a B2 glenoid and 1 had a C glenoid.
Improvement in posterior subluxation was noted in 16 of the
22 B2 glenoids.
• The average joint space at final radiographic analysis was 1.5 mm.
Discussion
Outcome measures from this study demonstrated improvement in
postoperative version and re-centering of the humeral head in
subluxed osteoarthritic shoulders.
Joint space was still narrow after the procedure. However,
improvement in clinical outcomes suggest that restoring joint space
may not be as important as purported in previous literature.
These results demonstrate improved short-term clinical outcomes
when compared to those reported in previous literature. Limitations
of this study include short-term follow-up, the lack of a control
group, and a suboptimal follow-up rate (69% clinical, 53%
radiologic).
This procedure may represent a viable alternative to polyethylene
glenoid resurfacing for the treatment of severe
glenohumeral osteoarthritis in the young and/or active patient.
Figure 2A-B: Pre-operative
anteroposterior and axillary views of a
60 year old male with an arthritic B2
glenoid. Figure 2.C-D: Two year
postoperative anteroposterior and
axillary view showing corrected
subluxation
Results
• 44 patients with preoperative and postoperative ASES, SANE, Constant
Score (CS) and level of satisfaction score
• 39 patients available for radiographic review at a minimum of 2 years
after surgery (follow up range 24 to 69 months, average 38 months).
2.A 2.D
Figure 3.A: Pre-operative forward
flexion of the same patient. Figure 3.B:
Two year post operative forward
flexion of the same patient.
References
1. Elhassan, B., M. Ozbaydar, D. Diller, L. D. Higgins and J. J. Warner (2009). "Soft-tissue resurfacing
of the glenoid in the treatment of glenohumeral arthritis in active patients less than fifty years old."
J Bone Joint Surg Am 91(2): 419-424.
2. Hammond, L. C., E. C. Lin, D. P. Harwood, T. W. Juhan, E. Gochanour, E. L. Klosterman, B. J. Cole, G. P.
Nicholson, N. N. Verma and A. A. Romeo (2013). "Clinical outcomes of hemiarthroplasty and
biological resurfacing in patients aged younger than 50 years." J Shoulder Elbow Surg 22(10): 1345-
1351.
3. Johnson, M. H., E. S. Paxton and A. Green (2015). "Shoulder arthroplasty options in young (<50
years old) patients: review of current concepts." J Shoulder Elbow Surg 24(2): 317-325.
4. Strauss, E. J., N. N. Verma, M. J. Salata, K. C. McGill, C. Klifto, G. P. Nicholson, B. J. Cole and A. A.
Romeo (2014). "The high failure rate of biologic resurfacing of the glenoid in young patients
with glenohumeral arthritis." J Shoulder Elbow Surg 23(3): 409-419.
5. Walch, G., A. Boulahia, P. Boileau and J. F. Kempf (1998). "Primary glenohumeral
osteoarthritis: clinical and radiographic classification. The Aequalis Group." Acta
Orthop Belg 64 Suppl 2: 46-52.
3.A 3.B
Table I. Comparison of pre-operative subjective scores
and range of motion to post-operative subjective scores
and range of motion.
2.B
2.C
Outcome
Average
Pre-operative
Average
post-operative
Average
change
ASES Score 31.6 86.1 54.5
Adjusted Constant
Score
47.1 86.6 39.5
SANE (% of normal) 25.5 76.1 50.6
Forward Flexion (from
thorax)
113 145 32
Abduction (degrees) 108 141 33
Internal Rotation (CS) 4.5 6.3 1.8
External Rotation
(degrees)
40 59 19
Figure 1.A: Intraoperative
photo showing sutures
passing through the graft.
Figure 1.B: Fixated graft