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March 2008

Shoulder Resurfacing for Arthritis
Bernard F. Hearon, M.D.

Shoulder joint arthritis is a common cause of shoulder pain among patients who are evaluated in our office. Seniors are living longer and their shoulder (glenohumeral) joints are wearing out over time causing arthritis. Younger patients, who participate in contact sports and weight lifting activities, may also develop shoulder problems leading to arthritis. With increasing frequency, some athletes are discovered to have focal or limited areas of arthritis during shoulder arthroscopy procedures.

Shoulder joint arthritis occurs when the smooth articular cartilage surface of the joint begins to break down and fragment. There are many causes or types of shoulder arthritis including osteoarthritis, rheumatoid arthritis, post-traumatic arthritis and rotator cuff deficiency arthritis. If nonoperative treatments (such as activity modification, nutritional supplements and anti-inflammatory medicines) fail to relieve the shoulder pain associated with arthritis, then surgical treatment options should be considered.

For many years, the standard surgical treatment for patients in the United States with severe pain from shoulder arthritis has been shoulder replacement surgery performed with a stemmed implant as seen in Fig 1. This procedure requires removal of the humeral head, reaming of the humeral shaft and implantation of humeral stemmed component and solid hemispherical metallic head. Thus, the implant is used to replace the bone and diseased cartilage which have been removed.

Figure 1 Stemmed Shoulder Replacement

Figure 2 Shoulder Resurfacing Implant

Over the last few years, newer implants, used to resurface all or part of the arthritic humeral head, have been introduced in the United States. These implants require the removal of much less bone during surgery and may be used to resurface a focal articular cartilage defect in the shoulder as shown in Fig 2. In our practice, we are now offering shoulder resurfacing arthroplasty to patients with shoulder arthritis who may benefit from this new technology.

Advantages of resurfacing shoulder arthroplasty over standard shoulder replacement are numerous. Limited resurfacing targets only the diseased cartilage and preserves cartilage not yet affected by the arthritic process. Much more of the bone beneath the diseased cartilage is also preserved. While both procedures require a long incision on the front of the shoulder, the resurfacing arthroplasty can be done more quickly and with less blood loss than the standard shoulder replacement. Also, fewer surgical and postoperative complications may be associated with the resurfacing procedure.

Treatment of shoulder arthritis in young adult patients is particularly challenging because the implants may wear out over time, requiring patients to have revision surgery in the future. A recent study examined 36 patients, average age 42 years, who had resurfacing implants for shoulder arthritis. Thirty-five of the 36 patients were satisfied with the result two years after surgery. Longer follow-up of patients treated with resurfacing implants in Europe, where some of these implants have been used for more than twenty years, shows good intermediate and long-term results as well.

Shoulder resurfacing implants are not appropriate for all patients with shoulder arthritis. Patients who may benefit from these devices must have adequate bone to support the implant and the socket (glenoid) portion of the shoulder must be relatively free of arthritis. If you have shoulder arthritis, we invite you to schedule an evaluation in our office to determine the best treatment option for you.

Want more information online? Go to www.biomet.com or www.arthrosurface.com.

References

1. Bailie DS, Llinas PJ, Ellenbecker TS. Cementless Humeral Resurfacing Arthroplasty in Active Patients Less Than Fifty-five Years of Age. J Bone Joint Surg, 90-A(1): 110-17, January 2008.

2. Scalise JJ, Miniaci A, Iannotti JP. Resurfacing Arthroplasty of the Humerus: Indications, Surgical Technique and Clinical Results. Tech Shoulder Elbow Surg, 8(3): 152-60, September 2007.