Shoulder - Clinical Data

Hammond G, Tibone JE, McGarry MH, Jun BJ, Lee TQ.
J Bone Joint Surg Am. 2012 Jan 4;94(1):68-76.

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Anatomic Humeral Head Resurfacing. Review of Clinical Outcomes and Case Presentations.

Davidson P, Lemak L, Uribe J, Zvijac, J, Litchfield R, Miniaci A, Siegel J
Arthrosurface 2006

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Humeral head resurfacing has recently gained increased interest with clinicians. A novel anatomic resurfacing technology has been introduced to the market that allows for intraoperative mapping of the joint surface geometry. The objective of this investigation is to quantify the effectiveness of the HemiCAP® contoured articular shoulder prosthesis in the management of pain and restoration of shoulder function. This review examines short term multicenter clinical results. Between March 2004 and January 2006, 62 patients underwent humeral head resurfacing at six participating institutions. 36 patients were male, 26 female. The mean age at the time of surgery was 60 years (range 25-84). The mean follow-up was 8 months (range 3-23). 45 patients were treated for glenohumeral osteoarthritis, eight for avascular necrosis, four received treatment for focal full thickness chondral defects, four were treated for humero-acromial arthritis, and one for rheumatoid arthritis. Defect sizes were adequately covered with the following diameters: 35mm (32 implants), 30mm (24 implants), and 25mm (6 implants). Mean WOOS (from 1234 to 243), ASES (from 38 to 70), pain VAS (from 54 to 18), SST (from 3.3 to 8.4), and Constant scores (from 55 to 78) demonstrated marked improvement over the follow-up period. The most frequent concomitant procedure was rotator cuff repair in 13 patients. Advanced glenoid wear, found at the time of implantation, lead to one clinical failure due to unimproved shoulder pain. 95% of the patients reported a good to excellent result at last follow-up.
Intraoperative joint surface geometry mapping permits an anatomic restoration of the humeral head. Compared to existing shoulder arthroplasty procedures, the HemiCAP® system is a joint preserving procedure with minimal removal of bone stock and preservation of healthy cartilage. The surgical technique is reproducible, has a short learning curve and causes minimal impact on future surgery. Treatment outcomes provide pain relief and return to activities across a variety of indications.

Resurfacing Arthroplasty of the Humerus: Indications, Surgical Technique, and Clinical Results

Scalise, Jason J. MD; Miniaci, Anthony MD, FRCSC; Iannotti, Joseph P. MD, PhD

Techniques in Shoulder & Elbow Surgery:2007 - Volume 8 - Issue 3 - pp 152-160
doi: 10.1097/bte.0b013e31806196e6

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Resurfacing arthroplasty of the shoulder is not a new concept in orthopedic surgery. Although only a few reports describe the indications, technique, and results, experience with these devices continues to grow. A specific advantage of resurfacing arthroplasty, the concept of a bone-preserving procedure, may prove to be particularly important in younger patients who require prosthetic arthroplasty surgery. The indications and surgical technique are illustrated in this review. Our early clinical results with 2 humeral resurfacing prostheses reflect those of other published reports; namely, favorable clinical outcomes can be expected.

The Management of Localized Articular Cartilage Lesions of the Humeral Head in the Athlete

Courtney K. Dawson, Robert H. Rolf, , Thomas F. Holovacs,

Operative Techniques in Sports Medicine 2008, 16(1): 14-20.

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Localized articular cartilage lesions of the humeral head can be a source of persistent pain and functional decline in patients who have failed conservative treatment measures. Many are younger, active patients who pose a challenging management decision for surgeons. The goals of treatment should focus on maintaining humeral bone stock, restoring the contour of the articular surface, minimizing soft-tissue disruption, and relieving symptoms. There has been a trend toward humeral resurfacing arthroplasty and away from stemmed components over the past few decades for younger patients potentially requiring future revision surgery. More recently, the HemiCAP resurfacing system (Arthrosurface, Franklin, MA) has been used for localized defects in patients with Hill-Sachs and reverse Hill-Sachs lesions, avascular necrosis, focal chondral defects, and humeral head osteoarthritis. Early, short-term outcome results of the HemiCAP system are encouraging. In this article, we describe our technique for management of localized articular cartilage defects of the humeral head using the HemiCAP resurfacing system.

Biomechanical comparison of anatomic humeral head resurfacing versus hemiarthroplasty for functional glenohumeral positions

Gareth Hammond1,2, James E. Tibone1,2, Michelle H. McGarry1, Bong-Jae Jun1, Thay Q. Lee1

1Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System and University of California, Irvine, Long Beach, CA; 2Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA tqlee@med.va.gov

Transactions Vol.33, San Francisco, CA, 2008

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Partial humeral head resurfacing for osteonecrosis.

Uribe JW, Botto-van Bemden A.
UHZ Sports Medicine Institute, Coral Gables, FL 33146, USA.
J Shoulder Elbow Surg. 2009 Sep-Oct;18(5):711-6. Epub 2009 Jan 30.

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The purpose of this study is to present our experience treating patients in the advanced stages of osteonecrosis of the humeral head with partial resurfacing of the humeral head. This is a prospective series of 12 shoulders in 11 patients diagnosed with osteonecrosis of the humeral head who underwent partial humeral head resurfacing. Their mean age was 56 years. Preoperative and postoperative standardized evaluations included history, physical examination, radiographs, and clinical scoring systems, including the Western Ontario Osteoarthritis of the Shoulder index, Shoulder Score Index derived from the American Shoulder and Elbow Surgeons evaluation form, Constant score, and score on the visual analog scale for pain. The mean follow-up was 30 months. Postoperatively, all patients reported significant pain relief. Scores on the visual analog scale for pain improved from 75 preoperatively to 16 postoperatively (P < .001). Physical examination showed significant improvements in functional outcomes as well. Forward elevation improved from a mean of 94 degrees preoperatively to 142 degrees postoperatively (P < .001). Good to excellent results were also observed for the Western Ontario Osteoarthritis of the Shoulder index, Shoulder Score Index, and Constant score. This prospective series on partial resurfacing of the humeral head for patients with advanced-stage osteonecrosis has shown it to be effective in relieving pain and restoring function.

Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability.

Moros C, Ahmad CS.
North Shore-Long Island Jewish/Peninsula Medical Center, Far Rockaway, NJ, USA.
Orthopedics. 2009 Aug;32(8). pii: orthosupersite.com/view.asp?rID=41928. doi: 10.3928/01477447-20090624-21.
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Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique. Anteroinferior glenoid deficiency has also been a well-documented source of recurrent instability. The Latarjet coracoid transfer procedure corrects the glenoid defect by restoring the architecture of the inferior rim. Although coracoid transfer addresses containment on the glenoid, a concomitant large humeral head defect is at risk for engagement on the corrected glenoid. This article describes a case of a 50-year-old man presenting with recurrent right shoulder dislocations status post-open stabilization procedure 10 years prior. Radiologic evaluation demonstrated a large Hill-Sachs lesion with adjacent chondral derangement and a nonunion bony Bankart lesion. The Arthrosurface HemiCap humeral head resurfacing prosthesis (Arthrosurface Inc, Franklin, Massachusetts) was used to address the Hill-Sachs lesion with a Latarjet coracoid transfer procedure. We were unable to identify examples in the literature of the HemiCap used in the correction of a Hill-Sachs lesion for recurrent anterior instability. The HemiCap prosthesis has the benefit of correcting the Hill-Sachs lesion and adjacent chondral defect while preserving uninvolved articular surface. The combination of surgical interventions produced a successful result.

Case series: Combined large Hill-Sachs and bony Bankart lesions treated by Latarjet and partial humeral head resurfacing: a report of 2 cases.

Grondin P, Leith J.
Department of Orthopedics, University of British Columbia Hospital, Vancouver, BC.
Can J Surg. 2009 Jun;52(3):249-54.
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The bony conformity of the glenoid and humeral head articular surfaces provides some of the stability of the shoulder. Frequently, patients with recurrent dislocations have bony deficits in one or both of these surfaces. Glenohumeral instability with substantial glenoid defects or engaging
Hill–Sachs lesions pose a difficult challenge for orthopedic surgeons. Burkhart and colleagues report a 67% recurrence rate using only soft tissue repair in patients with recurrent dislocations and glenoid bony defects. Treatment options for glenoid bony defects vary from soft-tissue repair only if the defect is small to bone grafting and Bristow–Latarjet coracoid transfers if the defect is large. Small or nonengaging Hill–Sachs lesions are usually left alone while addressing the Bankart lesion, but they must be addressed when the Hill–Sachs lesion engages. Treatments include osteochondral grafting, infraspinatus transfer, humeral head plasty and derotational osteotomies. Ignoring a large deficit may lead to failure of the soft tissue Bankart repair.
We present the cases of 2 patients whose shoulders required interventions for both the humeral head and the glenoid to remain stable. We reconstructed the glenoid using a Latarjet procedure, and we treated the Hill–Sachs lesion with focal arthroplasty using the HemiCAP implant (Arthrosurface), a novel approach to the problem. At 1 year follow-up, neither patient had experienced a recurrence.

Case reports: Two cases of glenohumeral chondrolysis after intraarticular pain pumps.

Anakwenze OA, Hosalkar H, Huffman GR.
Department of Orthopaedic Surgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2010 Sep;468(9):2545-9. Epub 2010 Jan 29.

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Acute idiopathic chondrolysis in young adults is rare. The etiology often is unknown and outcomes can be devastating owing to rapid development of painful secondary osteoarthritis. There have been some recent reports of chondrolysis after arthroscopic shoulder procedures. Animal and laboratory data suggest chondrolysis is related to the use of intraarticular pain pumps, although there is no conclusive evidence that this is causative in patients.We present two cases of young adults with chondrolysis of the humeral head after intraarticular pain pump use with humeral head resurfacing and biologic glenoid resurfacing.Several authors report glenohumeral chondrolysis after shoulder arthroscopy involving the use of bupivacaine pain pumps. In addition, experimental animal studies have confirmed the presence of chondrolysis after bupivacaine infusion. These cases provide additional evidence of an important association between postarthroscopic chondrolysis of the glenohumeral joint and the use of bupivacaine pain pumps

Use of a partial humeral head resurfacing system for management of an osseous mechanical block to glenohumeral joint range of movement secondary to proximal humeral fracture malunion.

Eleftheriou K, Al-Hadithy N, Joshi V, Rossouw D.
Department of Trauma and Orthopaedics, Barnet General Hospital, Wellhouse Lane, Town Centre, Barnet EN5 3DJ.
Int J Shoulder Surg. 2011 Jan;5(1):17-20.
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Malunion of proximal humeral fractures can lead to a severely impaired shoulder function. Loss of motion is often the main issue in patients and can be secondary to osseous, soft-tissue as well as neurological damage to the shoulder. Malunion of the articular surface of the humeral head can lead to pain, chronic degenerative changes secondary to joint incongruity and mechanical block to the range of movement. A 46-year-old otherwise healthy male chef presented with malunion and collapse of his previous plate fixation for a four-part proximal humerus fracture. We describe the first documented case of the use of a focal resurfacing system for dealing with such an osseous mechanical block in the presence of an otherwise preserved articular surface in a high-demand patient. HemiCAP can be successfully used in proximal humeral fracture malunion where there is a localized cartilage defect, allowing restoration of joint congruity while preserving the bone stock.

Surface arthroplasty for treating primary and/or secondary shoulder osteoarthrosis by means of the HemiCAP-Arthrosurface® system

Murilo Cunha Rafael dos Santos5, Nivaldo Souza Cardozo Filho6, Nicolas Gerardo Gómez Cordero
Rev Bras Ortop. 2011;46(3):288-92
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Objective: To present the surgical technique for the HemiCAP-Arthrosurface® system and evaluate our results from this technique for treating primary and/or secondary shoulder osteoarthrosis. Method: Between June 2007 and June 2009, 10 shoulders of 10 patients (nine with primary osteoarthrosis and one with avascular necrosis of the humeral head) underwent surface arthroplasty using the HemiCAP-Arthrosurface® system to correct the problem.
The follow-up time ranged from six to 29 months (mean of 17 months). The patients’ ages ranged from 62 to 73 years (mean of 67.5 years). Six patients were female and four patients were male. The patients were followed up weekly for the first month after the surgical procedure and every three months thereafter. The clinic evaluation was done using the criteria of the University of California at Los Angeles (UCLA) and a visual analogue pain scale. Results: All the patients said that they were satisfied with the results from the surgical treatment, with a mean UCLA score of 30 points and a mean analogue pain score of two points. Conclusion: The HemiCAP- Arthrosurface® system for shoulder surgery for a specific group of patients is a technique that preserves the bone stock with good functional and antalgic results.

Surface Replacement: The HemiCAP Solution

Christopher J. Lenarz, MD, Yousef Shishani, MD Reuben Gobezie, MD
Seminars in Arthroplasty 2011,22(10:10-13.
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Partial resurfacing of the humeral head with the Hemicap implant has recently become available. Previously, the use of resurfacing in the glenohumeral joint has been used for the treatment of osteoarthritis, cuff tear arthropathy, rheumatoid arthritis, and avascular necrosis. The technique has provided significant pain relief as well as improved function in all pathologies in the available short to midterm follow-up studies. The advent of the Hemicap implant provides the treating physician with an option of a more limited resurfacing for focal defects, such as those occurring with avascular necrosis and Hill-Sachs and reverse Hill Sachs lesions from instability.

Focal Humeroacromial Resurfacing in Patients with Irreparable Massive Rotator Cuff Tears and Normal Glenohumeral Joints.

McKenna W, Chandler T.

Arthrosurface 2011

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