CORR Insights®: Foreign Body Reaction to Acellular Dermal Matrix Allograft in Biologic Glenoid Resurfacing

Abstract

Glenohumeral joint arthritis in young patients poses a challenging problem for the orthopaedic surgeon. Ten-year survivorship for total shoulder implants in young patients has been reported as low as 62.5%. Glenoid failure [1] is the most common cause for revision. Revision of a loose glenoid is technically challenging due to glenoid bone loss and polyethylene induced osteolysis. Unfortunately, hemiarthroplasty for patients less than 60 years old has a 4.5-times higher risk of revision surgery in early followup compared with total shoulder arthroplasty [2]. In attempting to bypass the glenoid component failure and improve the results of hemiarthroplasty, surgeons search for biologic options to address an arthritic glenoid. Multiple tissues have been used to resurface the glenoid, including autologous joint capsule and fascia lata, allograft Achilles or meniscus and acellular matrix-based scaffolds. These acellular grafts should provide a substrate allowing for the possibility of repopulation of the tissue with host cells [4]. Results for these techniques, however, have not been promising, demonstrating a 26% reoperation rate at just 2-years followup [3].