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Updated: Jun 5 2021

Shoulder Resurfacing

  • 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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