Humeral Head Replacement Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid in Young Patients

Michael A. Wirth, MD

Humeral head replacement has historically been favored over total shoulder arthroplasty for the management of specific shoulder conditions such as humeral head osteonecrosis with an intact glenoid cartilaginous surface, cuff tear arthropathy with fixed upward displacement of the humeral head, complex proximal humeral fractures in the elderly, and glenohumeral arthritis in young patients who have had failure of nonoperative measures.
Despite good early and midterm results with hemiarthroplasty, progressive glenoid erosion and painful glenoid arthritis are the most common reasons for failure and the need for reoperation. Moreover, the results of conversion of a hemiarthroplasty to a total shoulder replacement have proven to be less predictable than those of primary total shoulder arthroplasty secondary to limited range of motion, with unpredictable improvement in pain, and the more frequent need for subsequent operations.
In an effort to minimize the complications of painful glenoid arthritis and glenoid erosion associated with hemiarthroplasty and glenoid component failure associated with total shoulder arthroplasty, the proponents of the use of hemiarthroplasty in younger patients (less than sixty years of age) have explored adjunctive biological glenoid resurfacing with use of the anterior glenohumeral capsule, autogenous fascia lata, Achilles tendon allograft, and meniscal allograft.
In the corresponding JBJS article to this video supplement, the authors conclude that lateral meniscal allograft resurfacing of the glenoid can protect the glenoid from erosion, can minimize glenohumeral subluxation, and is associated with significant pain relief and improved function for two to five years when used in conjunction with hemiarthroplasty in younger patients with glenohumeral arthritis. However, they note the progressive decrease in glenohumeral joint space noted radiographically raises concern for both the long-term functional outcome and the durability of the glenoid bone-sparing effect.

Specifications

• Total Run Time: 14:46 minutes
• Catalog Number: 7073
• VJO Publication Date: December, 2010