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Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft.
Arthroscopy. 2017 Nov; 33(11):1920-1925.A

Abstract

PURPOSE

To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up.

METHODS

We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision.

RESULTS

Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 to 2 (median difference [Δ], 4 [95% CI, 3-6]; P < .0001), representing pain relief similar to total shoulder arthroplasty in young patients. Improvements in the median ASES score (from 47 to 76; Δ, 28 [95% CI, 17-40]; P < .0001), active forward elevation (from 110° to 140°; Δ, 20° [95% CI, 10°-35°]; P < .0001), and active external rotation (from 0° to 20°; Δ, 10° [95% CI, 5°-20°]; P < .0001) were noted. The mean age of revised shoulders (60 years [95% CI, 54-66 years]) was higher than that of surviving shoulders (53 years [95% CI, 50-57 years], P = .005). The preoperative ASES score of revised shoulders (34 [95% CI, 27-42]) was lower than that of surviving shoulders (47 [95% CI, 43-51], P = .006). No complications were noted.

CONCLUSIONS

AGR with dermal allograft is a safe option for joint preservation in selected patients, provides pain relief, and has an acceptable rate of revision to prosthetic arthroplasty at short-term to midterm follow-up. Increased age and lower preoperative ASES score were risk factors for failure of AGR.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Authors+Show Affiliations

The San Antonio Orthopaedic Group and Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.. Electronic address: Hartzler.rob@gmail.com.Cape Shoulder Institute, Cape Town, South Africa.Cape Shoulder Institute, Cape Town, South Africa.The San Antonio Orthopaedic Group and Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28668181

Citation

Hartzler, Robert U., et al. "Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 33, no. 11, 2017, pp. 1920-1925.
Hartzler RU, Melapi S, de Beer JF, et al. Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft. Arthroscopy. 2017;33(11):1920-1925.
Hartzler, R. U., Melapi, S., de Beer, J. F., & Burkhart, S. S. (2017). Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 33(11), 1920-1925. https://doi.org/10.1016/j.arthro.2017.04.005
Hartzler RU, et al. Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft. Arthroscopy. 2017;33(11):1920-1925. PubMed PMID: 28668181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft. AU - Hartzler,Robert U, AU - Melapi,Sabelo, AU - de Beer,Joe F, AU - Burkhart,Stephen S, Y1 - 2017/06/28/ PY - 2016/09/15/received PY - 2017/03/18/revised PY - 2017/04/03/accepted PY - 2017/7/3/pubmed PY - 2018/6/5/medline PY - 2017/7/3/entrez SP - 1920 EP - 1925 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 33 IS - 11 N2 - PURPOSE: To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up. METHODS: We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision. RESULTS: Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 to 2 (median difference [Δ], 4 [95% CI, 3-6]; P < .0001), representing pain relief similar to total shoulder arthroplasty in young patients. Improvements in the median ASES score (from 47 to 76; Δ, 28 [95% CI, 17-40]; P < .0001), active forward elevation (from 110° to 140°; Δ, 20° [95% CI, 10°-35°]; P < .0001), and active external rotation (from 0° to 20°; Δ, 10° [95% CI, 5°-20°]; P < .0001) were noted. The mean age of revised shoulders (60 years [95% CI, 54-66 years]) was higher than that of surviving shoulders (53 years [95% CI, 50-57 years], P = .005). The preoperative ASES score of revised shoulders (34 [95% CI, 27-42]) was lower than that of surviving shoulders (47 [95% CI, 43-51], P = .006). No complications were noted. CONCLUSIONS: AGR with dermal allograft is a safe option for joint preservation in selected patients, provides pain relief, and has an acceptable rate of revision to prosthetic arthroplasty at short-term to midterm follow-up. Increased age and lower preoperative ASES score were risk factors for failure of AGR. LEVEL OF EVIDENCE: Level IV, therapeutic case series. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/28668181/Arthroscopic_Joint_Preservation_in_Severe_Glenohumeral_Arthritis_Using_Interpositional_Human_Dermal_Allograft_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(17)30373-0 DB - PRIME DP - Unbound Medicine ER -