CLINICAL RESEARCH
Stemless
Humeral Prosthesis and Meniscal Allograft: Should We Abandon This Technique?
Martín Caloia,
Gerónimo Chamorro, Diego González Scotti, Hugo Caloia, Sergio E. Ronconi,
Alejandro Meritano, María Emilia Serur, Agustín Davies
Section of Upper Limb Surgery, Orthopedics and
Traumatology Department, Hospital Universitario Austral, Pilar, Buenos Aires,
Argentina
ABSTRACT
Introduction: Managing
advanced glenohumeral osteoarthritis in young, active patients is complex and
controversial. This study reports outcomes after humeral resurfacing arthroplasty combined with
meniscal allograft. Materials and Methods: Twenty-five patients (mean age, 47.3
years) were included, with a mean follow-up of 66.1 months. Pre- and
postoperative assessments included imaging, range of motion, and functional
scores (VAS, ASES, and Simple Shoulder Test). In a subgroup of 10 patients, the
same variables were reassessed at 6 years postoperatively. Results:
One-year outcomes improved significantly versus baseline: VAS decreased from
7.3 to 2.8; ASES increased from 31.3 to 70.5; SST from 3.6 to 7.3; forward
elevation improved from 70° to 135°; abduction from 57° to 103°; external
rotation with the arm at side from 25° to 55°; and internal rotation from 1.4
to 4 points (0–5 scale). In the 10 patients evaluated at 6 years, there was a
statistically significant deterioration across all variables relative to the
1-year results, although values remained substantially better than preoperative
levels. Radiographs showed progressive glenohumeral joint-space
narrowing in all patients. Conclusions: This surgical technique yielded meaningful
improvements in pain, mobility, and quality of life and proved safe, with no
major complications.
Keywords: Prosthesis;
humeral head; osteoarthritis; allograft; meniscus; hemiarthroplasty.
Level of Evidence: IV
Prótesis humeral sin vástago y aloinjerto meniscal: ¿se
debe abandonar?
RESUMEN
Introducción: El
tratamiento de la artrosis glenohumeral avanzada en pacientes jóvenes y activos
es complejo y controvertido. El objetivo de esta presentación es comunicar los
resultados de una serie de pacientes sometidos a artroplastia humeral de
superficie y aloinjerto de menisco. Materiales y Métodos: Se incluyó a 25 pacientes (edad promedio 47.3 años) con un
seguimiento promedio de 66.1 meses. Antes de la cirugía y después, se evaluaron
los estudios por imágenes, el rango de movilidad y las escalas funcionales
(EAV, ASES y Simple Shoulder Test).
Se analizaron las mismas variables en un subgrupo de 10 pacientes a los 6 años
de la operación. Resultados: Los
valores preoperatorios mejoraron significativamente al año de seguimiento: EAV
de 7,3 a 2,8; ASES de 31,3 a 70,5; Simple
Shoulder Test de 3,6 a 7,3; elevación anterior de 70° a 135°, abducción de
57° a 103°, rotación externa con el brazo aducido de 25° a 55° y rotación
interna de 1,4 a 4 puntos (evaluada con un puntaje de 0 a 5). En los 10
pacientes evaluados a los 6 años de la cirugía, los resultados mostraron un
deterioro estadísticamente significativo en todas las variables, aunque con una
mejora sustancial respecto a los valores preoperatorios. En las radiografías,
se observó una pérdida progresiva de la luz articular glenohumeral en todos los
pacientes. Conclusiones: Con esta
técnica quirúrgica hemos obtenido buenos resultados en cuanto a la mejoría del
dolor, la movilidad y la calidad de vida, fue un procedimiento seguro y sin
complicaciones mayores.
Palabras clave:
Prótesis; cabeza humeral; artrosis; aloinjerto; menisco; hemiartroplastia.
Nivel de Evidencia: IV
Advanced glenohumeral osteoarthritis in young,
active patients is a difficult clinical problem with no ideal solution.
Management is especially challenging when conservative treatment fails and
there is extensive joint damage. Progressive pain, restricted motion, and high
functional demands in this population often limit the effectiveness of
nonoperative care.1,2
Traditionally, numerous options have been
described: arthroscopic debridement, glenoplasty, arthrodesis, partial or total
shoulder arthroplasty, and more recently, biologic therapies.3,4 Although hemiarthroplasty has been the
most frequently indicated procedure, its results have been inferior to total
arthroplasty because of long-term glenoid erosion and frequent conversion to
total prosthesis.5,6 Total
arthroplasty relieves pain and improves function, but complications such as
wear, glenoid loosening, and periprosthetic fracture limit its use in young,
active patients.2
Concerns about polyethylene durability at the
glenoid have fueled interest in biologic materials for non-prosthetic
reconstruction. Interposition using joint capsule, autogenous fascia lata,
Achilles tendon allograft, and meniscal allograft has been reported with
variable success.7-10
Meniscal allograft in young patients with knee
osteoarthritis has shown healing potential and durability.7,9 Cementless humeral resurfacing
prostheses yield outcomes comparable to stemmed implants in active young
patients, with fewer complications, and they facilitate future revisions by
preserving humeral bone stock.8
With these concepts in mind, the aim of this
study was to retrospectively evaluate short- and mid-term functional outcomes
in a group of active patients with glenohumeral osteoarthritis treated with
humeral resurfacing hemi-arthroplasty and biologic interposition using a
cryopreserved, non-irradiated lateral meniscal allograft from our tissue bank.
MATERIALS AND
METHODS
From June 2003 to June 2023, 30 patients with
symptomatic, advanced glenohumeral osteoarthritis underwent hemiarthroplasty
with a humeral surface prosthesis (Copeland Mark III®, MacroBond, Biomet,
Warsaw, IN, USA) combined with a non-irradiated frozen lateral meniscal
allograft from our institutional tissue bank. All procedures were performed by
the same experienced surgeon (level V on Tang’s expertise scale).11 Retrospective assessments were carried
out by Upper Limb Surgery staff who were not involved in the cases.
Inclusion criteria: 1) symptomatic glenohumeral
osteoarthritis, grade 3 (severe) per the Samilson–Prieto radiographic
classification12 (Table 1); 2) age ≤55 years; 3) treatment with
humeral resurfacing plus meniscal allograft; 4) pain (visual analog scale [VAS]
≥6) and functional limitation refractory to at least 8 months of conservative
treatment (NSAIDs, activity modification, rehabilitation, injections) or prior
arthroscopic synovectomy and lavage.
Exclusion criteria: 1) follow-up <1 year; 2)
rheumatoid arthritis or signs of active infection; 3) previous
hemiarthroplasty; 4) tears of two or more rotator cuff tendons.
Bipolar osteoarthritis
(involvement of both articular surfaces) was diagnosed based on 1) clinical
history, 2) radiographs to stage osteoarthritis per Samilson–Prieto,12 and 3) intraoperative findings in
patients who had previously undergone arthroscopy. Glenoid cartilage damage
(degeneration, erosions, asymmetric wear, and cartilage loss) was confirmed
intraoperatively before proceeding. All patients were carefully evaluated with
radiographs (AP, axillary, and AP with internal and external rotation), CT with
3D reconstruction and image suppression, and non-contrast MRI. These studies
were used to select the lateral meniscal allograft best suited to resurface the
glenoid according to morphotype and glenoid erosion (Walch criteria13) and to assess the presence of rotator cuff
injuries. CT was also obtained postoperatively (immediate, 6 months, 1 year,
then annually) to document the glenohumeral joint space achieved at surgery and
to monitor allograft wear over time.
Function was assessed preoperatively and at 1,
3, 6, and 12 months postoperatively during the first year, then annually.
Outcomes included VAS and active range of motion (abduction, forward elevation,
internal rotation, and external rotation with the arm adducted). Internal
rotation was graded by the highest vertebral level reached with the thumb
extended (Table 2).
The ASES (American
Shoulder and Elbow Surgeons) score and the Simple Shoulder Test (SST) were also collected.
Twenty-five of the 30 operated patients met
inclusion criteria. Twenty were men and five were women. Mean age was 47.3
years (range, 35–55). Twenty had right-sided involvement, and the dominant limb
was affected in 17 cases (Table 3).
Diagnoses included: sequelae of humeral
fracture-dislocation (2 cases) and prior surgery for anterior gleno-humeral
instability (20 cases): seven had open procedures (Putti-Platt [4], Bristow
[2], and unspecified anterior capsular plication [1]) and 13 had arthroscopic
procedures (Bankart repair, 10 with metal anchors and 3 with biodegradable
implants). In seven instability cases (open and arthroscopic), osteoarthritis
was accompanied by glenoid bone defects due to malpositioned implants
(incorrectly placed 3.5 mm screws or anchors). Five of these seven had
undergone exploratory arthroscopy with debridement for pain relief. The
remaining three cases were idiopathic primary osteoarthritis with concentric
joint narrowing. All patients were considered active and high demand based on
work or sport (Table 4).
Statistical
Analysis
Continuous variables are presented as mean ±
standard deviation (SD), and categorical variables as frequencies and
percentages. To compare VAS, ASES, and SST scores before surgery, after
surgery, and across follow-up in the full cohort, the nonparametric Friedman
test was used given the longitudinal, non-normal data. A p value <0.05 was
considered significant.
A specific subgroup of 10 patients who completed
a minimum of 6 years (72 months) of follow-up was analyzed for mid-term
outcomes. Paired comparisons in this subgroup were performed with the Wilcoxon
signed-rank test. Analyses were conducted with SPSS version 25.0 (IBM Corp.,
Armonk, NY, USA).
Surgical
Technique (Figure 1)
All procedures were performed under brachial
plexus block plus general anesthesia in the beach-chair position. A
deltopectoral approach was used in all cases. When necessary, the subscapularis
and anteroinferior capsule were elevated to obtain adequate tendon excursion,
including release of adhesions in the subcoracoid space. The anterior capsule
and subscapularis were elevated as a single layer to facilitate reattachment to
the greater tuberosity. If external rotation was markedly limited, priority was
given to repositioning the subscapularis by medializing it. Excessive posterior
excursion of the humeral head was addressed by closing the rotator interval
with simple Vicryl® sutures. Tenotomy and tenodesis of the long head of the
biceps at the superior aspect of the subscapularis were routinely performed.
The intra-articular biceps and the superior labrum were resected.
Glenoid step: to ensure
allograft viability and avoid rupture, fixation strategy was meticulous. Based
on intra-operative cartilage defects and asymmetric wear, the glenoid was
reamed to a bleeding bed with complete labral debridement. Asymmetric reaming
was performed when needed to correct deformity. The lateral meniscus,
previously resected from a cadaveric tibial plateau, was prepared on a side
table (Figure 2).
Leaving sufficient tissue for reinforcement, the
anterior and posterior horns were sutured together and the graft was positioned
according to the defects encountered, especially in Walch type B1 or B2
glenoids.13 Fixation was achieved with suture anchors, borrowing concepts from
heart-valve prosthesis fixation: the glenoid was divided into quadrants and at
least two anchors were placed in each quadrant (Figure
3).
Eight anchors were used. Early in the series
these were metallic (2.8 mm FASTak, Arthrex®), later biodegradable
(Bio-SutureTak®, Arthrex®), all with high-strength sutures (FiberWire®). The
meniscus was trialed and all sutures placed prior to final fixation.
Humeral step: after
controlled dislocation and humeral head preparation, an uncemented humeral
resurfacing prosthesis was implanted in all cases (Copeland Mark III®, MacroBond;
Biomet, Warsaw, IN, USA) (Figure 4).
Humeral bone defects larger than 5 mm in
diameter were filled with cancellous bone allograft plus 1 g of vancomycin
powder. When humeral head deformity was substantial, an image intensifier was
used to determine the cervicodiaphyseal angle and humeral version. Small
rotator cuff lesions were repaired with sutures; no procedures
were performed on the acromioclavicular joint or the subacromial space. After
meniscal fixation and prosthesis implantation, the subscapularis was reattached
to the greater tuberosity with 5.5 mm anchors, with the arm adducted and 10° of
external rotation. Layered closure and intradermal skin closure were performed.
No drains were used. Mean operative time was 135 ± 13.95 minutes (range,
120–180).
Postoperative
Rehabilitation Protocol
Weeks 1-6 (protection and passive
motion): continuous sling use (20° elevation in the scapular plane). From day 1, elbow
and wrist exercises and Codman pendulums were started. At 2 weeks, physical
therapy began; full passive flexion, adduction, and internal rotation were
allowed, while external rotation was limited to 45° to protect the meniscal
allograft.
From Week 7 (active motion and
progressive strengthening): full passive stretching of external
rotation and active motion
were initiated. Progressive strengthening began at 12 weeks. Return to sport
was individualized according to each patient’s progress and tolerance.
RESULTS
Twenty-five patients were evaluated with a mean
follow-up of 66.1 months (range, 21–156). Functional outcomes improved
progressively and significantly across all clinical scores.
Mean VAS pain decreased from 7.32 ± 1.31
preoperatively to 2.76 ± 1.14 at 12 months (p <0.00001; Friedman test). ASES
improved from 31.32 ± 5.54 to 70.52 ± 11.84 (p <0.00001), indicating
significant functional recovery. SST increased from 3.64 ± 1.02 to 7.28 ± 1.40
over the same period (p <0.00001), this indicates an improvement in
functional perception by the patient (Figure 5).
Active range of motion also improved. Forward
elevation increased from 70.0° ± 25.0° preoperatively to 135.3° ± 24.8° at 12
months. Abduction rose from 57.2° ± 5.8° to 103.4° ± 9.0°. External rotation
with the arm adducted improved from 25.1° ± 2.5° to 55.0° ± 4.6°. Internal
rotation, graded on an ordinal scale, improved from 1.48 ± 0.50 to 4.04 ± 0.72
over the same period (Figures 6 and 7).
With appropriate rehabilitation, 20 patients
returned to work or sport; 13 without restriction and seven at a lower level
than expected because of concern about trauma affecting durability.
Mid-term outcomes (6 years): in the
subgroup of 10 patients with at least 6 years of follow-up, we compared 12-month versus 6-year
outcomes regarding pain and function scores, as well as active ranges of motion
(Table 5) .
There was a statistically significant decline in
pain and function scores (VAS, ASES, SST) and in active range of motion
(forward elevation, abduction, external and internal rotation) at 6 years
relative to 12 months. Despite this decline, mean 6-year values still
represented substantial improvement over preoperative baselines.
Radiographic
findings: preoperatively, all 25 shoulders had Samilson–Prieto12 grade-3
osteoarthritis (loss of joint space, cysts,
and osteophytes) (Figures 6 and 7).
Seven had asymmetric glenoid wear (Walch type B1
in 4 and B2 in 313). In addition, seven
shoulders had moderate subluxation and one had severe
subluxation. Postoperatively, subluxation resolved in 22 shoulders and
persisted mildly in three. Mean glenohumeral joint space increased from 1.2 mm
(range, 0–3) to 3.4 mm (range, 1–5) (Figure 8).
Follow-up CT demonstrated progressive
joint-space reduction due to meniscal allograft wear, correlated with time. On
last-follow-up CTs, glenoid erosion was classified as minimal/none in 15
patients (60%), moderate in 7 (28%), and severe in 3 (12%). These qualitative
findings confirm long-term glenoid wear despite meniscal interposition; erosion
was an anticipated complication.
Intraoperative notes included rotator cuff
repair with nonabsorbable sutures in two patients with prior humeral
fracture-dislocation (one supraspinatus tear, one subscapularis tear). Five
patients had variable numbers of loose bodies.1-3
No infections occurred. One patient had an uncomplicated postoperative
hematoma, and one woman with osteonecrosis from fracture-dislocation had poor
functional outcome but marked pain improvement.
Treating glenohumeral osteoarthritis in young,
active patients is complex and controversial. Primary wear is uncommon;
secondary causes after arthroscopic instability surgery are more frequent.14 Conservative care may help initially but
is insufficient in advanced stages. Current literature favors total shoulder
arthroplasty for short- and mid-term clinical outcomes,15 yet higher complication and revision
rates have been reported in younger patients, mainly due to glenoid component
wear.16,17 A systematic review
found high revision (17.4%) and complication (9.4%) rates in patients younger
than 65 years, with glenoid lucency in 54% at 9.4 years.16 A Mayo Clinic study of more than 5000
cases showed that older age is associated with lower risks of reoperation,
revision, mechanical failure, and infection.17
The risk of revision decreased 3% per year after age 50, and infection risk
decreased 1% after age 55. Patients aged 50–65 years had 35% fewer revisions,
and those older than 65 had 55% fewer, compared with patients younger than 50.
Other studies also report increased revisions in younger patients, with
significant glenoid failures at 10 years.18,19
In response, the concept of “buying time and
quality of life” has been proposed,20
based on biologic interposition options that delay joint deterioration without
compromising future surgery. One of the pioneers in proposing this technique
was Burkhead,9 who paired
hemiarthroplasty with autografts (capsule, fascia lata) or allografts
(Achilles), reporting variable but encouraging results. In this study, we chose
meniscal interposition—tailored to the articular surface—based on favorable
survivorship in young knees and its mechanical advantages: load transmission,
reduced cartilage stress, shock absorption, stability, lubrication, and
chondrocyte nutrition.21 The
shape of the lateral meniscus, with the anterior and posterior horns sutured
together, allows an excellent fit to the glenoid and humeral head, decreasing
glenohumeral pressure by about 10% through force dispersion.22,23 Meniscal interposition aims to improve
congruence and act as a biologic articular spacer. Among preservation methods,
frozen, frozen plus gamma irradiation, and cryopreservation are most used.24 Several studies report that cadaveric
meniscus should be cryopreserved, not lyophilized or irradiated, to preserve
structure and biomechanics.21,24-26
Many reports do not specify preservation method. In all our patients we used
non-irradiated cryopreserved lateral meniscal allograft, which may help explain
our clinical results by maintaining microstructure. We also favored humeral
resurfacing for several advantages: it better recreates normal biomechanics by
preserving the humeral center of rotation compared with stemmed
hemiarthroplasty, reduces operative time, and preserves bone for future
reResults of interposition arthroplasty are variable.20 Results of interposition arthroplasty are
variable. Puskas et al.6 reported
unacceptably high early failure in 17 hemiarthroplasties with various biologic
glenoid resurfacings; three of five meniscal cases required revision within 22
months. Lee et al.10 reported
complications in 32% of 19 patients treated with hemiarthroplasty and meniscal
allograft, with reoperation in six (32%) at 4.25 years. Both groups favored
total shoulder arthroplasty as a more predictable option with lower failure.
Others have reported positive outcomes.
Wirth2
treated 27 patients with hemiarthroplasty and lateral meniscal allograft,
observing pain relief and improved function at 2–5 years despite radiographic
joint narrowing. In long-term follow-up (mean 8.3 years), the same group27 reported very good functional outcomes,
though with a 30% revision rate. Despite narrowing, the humeral head remained
centered, possibly due to capsular release, soft-tissue balancing, rotator cuff
preservation, and glenoid reaming.
Direct comparative studies between interposition
and isolated hemiarthroplasty are scarce. In young patients, one study found
unfavorable results in both groups, with hemiarthroplasty alone superior for
pain relief and lower revision rates.28
Notably, interposition tissues varied (human acellular dermal matrix and
lateral meniscal allograft) and sterilization methods were not specified. More
comparative research is needed to determine optimal treatment.
Recently, hemiarthroplasty using a pyrocarbon
humeral head has emerged as a promising option for young, active patients.29,30 Pyrocarbon has an elastic modulus
similar to bone, offers durability and antimicrobial properties, and virtually
eliminates risk of stem loosening by avoiding intramedullary fixation.29 In a retrospective series, Barret et al.29 evaluated 62 active patients (mean age,
60 years) and reported 87% 10-year survivorship, with best results in type-A
glenoids. It is not recommended for type-B2 glenoids or subscapularis
insufficiency given high revision rates (44%). Garret et al.30 reported satisfactory clinical scores
with minimal glenoid erosion results in 37 patients treated with pyrocarbon
humeral heads at mid-term follow-up (5-9 years). At the end of follow-up,
glenoid erosion was minimal (moderate in 24% and severe in 8%), with
satisfactory clinical scores. Although not yet available in our setting, this alternative
represents meaningful progress toward durable solutions for young patients.
Despite the favorable early results in our
series, this retrospective case series without a control group has inherent
limitations, and findings should be interpreted accordingly. Strict inclusion
criteria yielded a limited sample, constraining statistical power. While we
observed significant mid-term improvements in pain and function, our 6-year
subgroup analysis showed a statistically significant decline in functional
scores and motion, and meniscal wear, although values remained substantially
better than preoperative baselines, indicating preserved function. Patients
with a history of fracture-dislocation fared worse than those with prior
instability, suggesting that altered tuberosities may impair biomechanics and
allograft viability, making such patients less suitable for this technique.
Strengths include sample homogeneity, systematic clinical and radiographic
follow-up, and a single high-experience surgeon, which ensures technical
consistency. The 6-year functional analysis, though small, is a valuable and
uncommon contribution for this intervention.
CONCLUSIONS
Humeral resurfacing with lateral meniscal
allograft remains a valuable option in young, active patients. With strict
patient selection and sound surgical technique, we achieved good improvements
in pain, motion, and quality of life. Bone-stock preservation is a significant
advantage that facilitates future revision if required.
REFERENCES
1.
Matsen FA 3rd, Rockwood CA Jr, Wirth MA, Lippitt
SB, Parsons M. Glenohumeral arthritis and its management. En: Rockwood CA Jr,
Matsen FA 3rd, Wirth MA, Lippitt SB (eds). The shoulder. 3rd ed. Philadelphia: WB Saunders; 2004, p.
879-100.
2. Wirth M.
Humeral head arthroplasty and meniscal allograft resurfacing of the glenoid. J Bone Joint Surg Am 2009;91(5):1109-19. https://doi.org/10.2106/JBJS.H.00677
3.
Fonte H, Amorim-Barbosa T, Diniz S, Barros L,
Ramos J, Claro R. Shoulder arthroplasty options for glenohumeral osteoarthritis
in young and active patients (<60 years old): a systematic review. J Shoulder Elbow Arthroplast 2020;6:24715492221087014. https://doi.org/10.1177/24715492221087014
4.
Rossi LA,
Piuzzi NS, Shapiro SA. Glenohumeral osteoarthritis: the role for
orthobiologic therapies: platelet-rich plasma and cell therapies. JBJS Rev
2020;8(2):e0075. https://doi.org/10.2106/JBJS.RVW.19.00075
5. Gartsman
GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing
of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am 2000;82(1):26-34. https://doi.org/10.2106/00004623-200001000-00004
6.
Puskas GJ, Meyer DC, Lebschi JA, Gerber C.
Unacceptable failure of hemiarthroplasty combined with biological glenoid
resurfacing in the treatment of glenohumeral arthritis in the young. J Shoulder Elbow Surg 2015;24(12):1900-7. https://doi.org/10.1016/j.jse.2015.05.037
7. Krishnan
SG, Nowinski R, Harrison D, Burkhead WZ. Humeral hemiarthroplasty with biologic
resurfacing of the glenoid for glenohumeral arthritis; two to fifteen-year
outcomes. J Bone Joint Surg Am
2007;89(4):727-34. https://doi.org/10.2106/JBJS.E.01291
8. Bishop
JY, Flatow EL. Humeral head replacement versus total shoulder arthroplasty:
clinical outcomes—a review. J Shoulder
Elbow Surg 2005;14(1 Suppl S):141S-146S. https://doi.org/10.1016/j.jse.2004.09.027
9.
Burkhead WZ Jr, Hutton KS. Biologic resurfacing
of the glenoid with hemiarthroplasty of the shoulder. J Shoulder Elbow Surg 1995;4(4):263-70. https://doi.org/10.1016/s1058-2746(05)80019-9
10.
Lee BK, Vaishnav S, Hatch III GFR, Itamura JM.
Biologic resurfacing of the glenoid with meniscal allograft: long-term results
with minimum 2-year follow-up. J Shoulder Elbow Surg 2013:22(2):253-60. https://doi.org/10.1016/j.jse.2012.04.019
11.
Tang JB, Giddins G. Why and how to report
surgeons’ levels of expertise. J Hand Surg Eur Vol 2016;41(4):365-6. https://doi.org/10.1177/1753193416641590
12.
Samilson RL, Prieto V. Dislocation arthropathy
of the shoulder. J Bone Joint Surg Am
1983;65(4):456-60. PMID: 6833319
13.
Walch G, Badet R, Boulahia A, Khoury A.
Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty1999;14(6):756-60. https://doi.org/10.1016/s0883-5403(99)90232-2
14.
Franceschi
F, Papalia R, Del Buono A, Vasta S, Maffulli N, Denaro V. Glenohumeral
osteoarthritis after arthroscopic Bankart repair for anterior instability. Am J Sports Med 2011;39(8):1653-60. https://doi.org/10.1177/0363546511404207
15.
Brolin TJ, Thakar OV, Abboud JA. Outcomes after
shoulder replacement surgery in the young patient: How do they do and how long
can we expect them to last? Clin Sports Med 2018;37(4):593-607. https://doi.org/10.1016/j.csm.2018.05.008
16.
Roberson TA, Bentley JC, Griscom JT, Kissenberth
MJ, Tolan SJ. Hawkins RJ, et al. Outcomes of total shoulder arthroplasty in
patients younger than 65 years: a systematic review. J Shoulder Elbow Surg 2017;26(7):1298-1306. https://doi.org/10.1016/j.jse.2016.12.069
17.
Wagner ER, Houdek MT, Schleck CD,
Harmsen WS, Sánchez-Sotelo J, Cofield R, et al. The role age plays in the outcomes and complications of shoulder
arthroplasty. J Shoulder Elbow Surg 2017;26(9):1573-80. https://doi.org/10.1016/j.jse.2017.01.020
18.
Denard PJ, Raiss P, Sowa B, Walch G. Mid- to
long-term follow-up of total shoulder arthroplasty using a keeled glenoid in
young adults with primary glenohumeral arthritis. J Shoulder Elbow Surg 2013;22(7):894-900. https://doi.org/10.1016/j.jse.2012.09.016
19. Brewley
Jr EE, Christmas KN, Gorman II RA, Downes KL, Mighell MA, Frankle MA. Defining
the younger patient: age as a predictive factor for outcomes in shoulder
arthroplasty. J Shoulder Elbow Surg
2020;29(7):S1-S8. https://doi.org/10.1016/j.jse.2019.09.016
20.
Iagulli N, Field L, Hobgood R, Hurt J, Charles
R, O´Brien M, et al. Surface replacement arthroplasty of the humeral head in
young active patients: midterm results. Orthop J Sports Med 2014;2(1):2325967113519407. https://doi.org/10.1177/2325967113519407
21.
Lee SR, Kim JG, Nam SW. The tips and pitfalls of
meniscus allograft transplantation. Knee Surg Relat Res 2012;24(3):137-45. https://doi.org/10.5792/ksrr.2012.24.3.137
22.
Yamaguchi K, Ball CM, Galatz LM, Levine WN.
Meniscal allograft interposition arthroplasty of arthritic shoulder: early
results and review of the technique. Presented at 18th Open Meeting American
Shoulder and Elbow Surgeons. Dallas TX; 2002.
23. Nicholson GP, Goldstein JL, Romeo AA, Cole BJ,
Hayden JK, Twigg SL, et al. Lateral meniscus allograft biologic glenoid
arthroplasty in total shoulder arthroplasty for young shoulders with
degenerative joint disease. J Shoulder
Elbow Surg 2007;16(5 Suppl):261-6. https://doi.org/10.1016/j.jse.2007.03.003
24.
Jacquet C, Erivan R, Argenson JN, Parratte S,
Ollivier M. Effect of 3 preservation methods (freezing, cryopreservation, and
freezing + irradiation) on human menisci ultrastructure: an ex vivo comparative
study with fresh tissue as a gold standard. Am J Sports Med 2018;46(12):2899-2904.
https://doi.org/10.1177/0363546518790504
25.
Zhang J, Song GY, Chen XZ, Li Y, Li X, Zhou JL.
Macroscopic and histological evaluations of meniscal allograft transplantation
using gamma irradiated meniscus: a comparative in vivo animal study. Chin Med J (Engl) 2015;128(10):1370-5. https://doi.org/10.4103/0366-6999.156784
26.
Bui D, Lovric V, Oliver R, Bertollo N, Broe D,
Walsh WR. Meniscal allograft
sterilisation: effect on biomechanical and histological properties. Cell Tissue Bank 2015;16(3):467-75. https://doi.org/10.1007/s10561-014-9492-3
27. Bois AJ,
Whitney IJ, Somerson JS, Wirth MA. Humeral head arthroplasty and meniscal
allograft resurfacing of the glenoid: a concise follow-up of a previous report
and survivorship analysis. J Bone Joint
Surg Am 2015;97(19):1571-7. https://doi.org/10.2106/JBJS.N.01079
28. Hammond
LJ, Lin EC, Harwood DP, Juhan TW, Gochanour E, Klosterman EL, et al. Clinical
outcomes of hemiarthroplasty and biological resurfacing in patients aged
younger than 50 years. J Shoulder Elbow
Surg 2013;22(10):1345-51. https://doi.org/10.1016/j.jse.2013.04.015
29. Barret H,
Garret J, Favard L, Bonnevialle N, Collin P, Gauci MO, et al. Long-term
(minimum 10 years) survival and outcomes of pyrocarbon interposition shoulder
arthroplasty. J Shoulder Elbow Surg
2025;34(3):739-49. https://doi.org/10.1016/j.jse.2024.05.026
30.
Garret J, Cuinet T, Ducharne L, van Rooij F,
Saffarini M, Nover L, et al. Pyrocarbon humeral heads for hemishoulder
arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at
5-9 years of follow-up. J Shoulder Elbow Surg 2024;33(2):328-34. https://doi.org/10.1016/j.jse.2023.06.021
M. Caloia ORCID ID: https://orcid.org/0000-0002-8103-3036
A. Meritano ORCID ID: https://orcid.org/0000-0001-5419-1859
D. Gónzalez Scotti ORCID ID: https://orcid.org/0000-0001-9564-4834
M. E. Serur ORCID ID:
https://orcid.org/0009-0009-4222-3724
H. Caloia ORCID ID: https://orcid.org/0000-0001-9288-1359
A. Davies ORCID ID: https://orcid.org/0009-0005-6313-5441
S. E. Ronconi ORCID ID:
https://orcid.org/0009-0000-9562-9976
Received on October 11th, 2024.
Accepted after evaluation on June 20th, 2025 • Dr.
Gerónimo Chamorro • gch.chamorro@gmail.com • https://orcid.org/0009-0009-3235-3840
How to cite
this article: Caloia M, Chamorro G, González Scotti
D, Caloia H, Ronconi SE, Meritano A, Serur ME, Davies A. Stemless Humeral
Prosthesis and Meniscal Allograft: Should We Abandon This Technique? Rev Asoc Argent Ortop Traumatol
2025;90(4):310-325. https://doi.org/10.15417/issn.1852-7434.2025.90.4.2046
Article Info
Identification: . https://doi.org/10.15417/issn.1852-7434.2025.90.4.2046
Published: August, 2025
Conflict of interests: The authors declare no conflicts
of interest.
Copyright: © 2025, Revista de la Asociación Argentina de
Ortopedia y Traumatología.
License: This article is under Attribution-NonCommertial-ShareAlike 4.0
International Creative Commons License (CC-BY-NC-SA 4.0).