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Prosthetic Resurfacing
  • Definition
    • humeral head arthroplasty with a non-stemmed, metal prosthesis 
    • may or may not be mated with glenoid prosthesis or biologic resurfacing
  • Advantages over conventional stemmed prosthesis 
    • no osteotomy is needed
      • no change in anatomic offset or version
        • improved restoration of normal biomechanics
    • minimal bone resection
    • shorter operative time
    • low prevalence of humeral periprosthetic fracture
    • easy revision to conventional arthroplasty if needed
  • Indications
    • cases in which the humerus anatomy is abnormal, causing:
      • difficulty with dislocation
      • difficulty with stem insertion
    • examples
      • humeral dysplasia
        • developmental
        • secondary
          • Apert's disease
          • epiphyseal dysplasias
          • chronic Erb's palsy
      • prior humerus fracture
        • proximal, metaphyseal, or diaphyseal malunion
        • hardware in place which blocks stem implantation
  • Outcomes
    • has demonstrated success in pain relief
    • does not reliably improve motion
    • at one year, considered inferior to outcomes of traditional stemmed prostheses
  • Complications
    • implant loosening is most common
Biologic Resurfacing
  • Also known as interpositonal allografting
  • Concept of putting soft tissue in glenoid to reduce symptoms and obviate need for TSA
  • Frequently combined with hemiarthroplasty of the humerus or humeral prosthetic resurfacing
  • Indications
    • young patients
    • rotator cuff arthropathy
    • GH narrowing following hemiarthroplasty
    • GH arthritis following arthroscopic stabilization procedures
  • Interpositional allografts include
    • fascia lata
    • meniscal allograft
    • achilles allograft
    • acellular dermal matrix
  • Outcomes
    • short-term outcomes (2-year)
      • improvement:
        • VAS pain score
        • ASES score
      • questionable improvement:
        • active forward elevation
        • active external rotation
        • active internal rotation
    • long-term outcomes
      • the rate of failure by 36-months has been reported at 44%
  • Complications
    • difficulty converting to TSA due to scarring within the glenohumeral joint
 

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