Unacceptable failure of osteochondral glenoid allograft for biologic resurfacing of the glenoid

Filippo Familiari,Christian Gerber,Bettina Hochreiter

doi:10.1186/s40634-021-00419-x

Abstract

PurposeGlenohumeral 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.MethodsBetween 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.ResultsOverall, 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).ConclusionThe 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 evidenceLevel IV, Case Series, Treatment Study.

Highlights

The management of the young and active patient with primary, posttraumatic or postoperative glenohumeralFamiliari et al Journal of Experimental Orthopaedics (2021) 8:111and HA may be associated with progressive glenoid erosion and unsatisfactory clinical outcome in the young individual [6, 7].Multiple interpositional soft-tissue grafts have been proposed to avoid or defer glenoid replacement including fascia lata, Achilles tendon allograft, anterior capsule, lateral meniscal allograft, and several dermal allografts [8,9,10,11]
A “rectangle” design was determined to be best and was chosen for five clinical pilot cases. The purpose of this clinical pilot study was to investigate the results of glenoid allograft resurfacing combined with a prosthetic humeral head replacement on the basis of positive in-vitro results and because the currently preferred options HA and total shoulder arthroplasty (TSA) are not yet considered a safe and durable solution
The most important finding is that the technically feasible glenoid allograft for resurfacing of a degenerated glenoid surface combined with anatomical HA does not work in-vivo

Summary

Introduction

The management of the young and active patient with primary, posttraumatic or postoperative glenohumeralFamiliari et al Journal of Experimental Orthopaedics (2021) 8:111and HA may be associated with progressive glenoid erosion and unsatisfactory clinical outcome in the young individual [6, 7].Multiple interpositional soft-tissue grafts have been proposed to avoid or defer glenoid replacement including fascia lata, Achilles tendon allograft, anterior capsule, lateral meniscal allograft, and several dermal allografts [8,9,10,11]. Introduced by Burkhead and Hutton in 1995 [12], interpositional soft tissue glenoid arthroplasty, combined with HA, has been proposed for glenohumeral OA in young patients. To assess the potential of glenoid allograft replacement associated with arthritic humeral head resurfacing, nine potential geometric designs of a scapular neck-glenoid allograft constructs were experimentally tested [21]. A “rectangle” design was determined to be best and was chosen for five clinical pilot cases The purpose of this clinical pilot study was to investigate the results of glenoid allograft resurfacing combined with a prosthetic humeral head replacement on the basis of positive in-vitro results and because the currently preferred options HA and TSA are not yet considered a safe and durable solution

Methods

Results

Conclusion