Partial Resurfacing for Humeral Head Defects Associated With Recurrent Shoulder Instability

Abstract

Recurrent traumatic shoulder instability is a complex clinical entity that commonly affects young, active patients. Humeral head defects are frequently associated with this condition, but specific treatment to stabilize the shoulder is rarely needed. Management options for defects of the humeral head that do necessitate treatment carry various risks and disadvantages, including the need for bone or soft tissue healing, complications related to hardware, and loss of motion. Partial prosthetic resurfacing has been reported as a treatment option. The current study retrospectively reviewed a cohort of patients with recurrent or locked anterior and posterior instability who underwent partial prosthetic humeral head resurfacing for significant Hill-Sachs and reverse Hill-Sachs lesions. At an average of 36.4 months after the index procedure, 16 patients were contacted by mail and telephone. Of the study group, 13 patients underwent partial resurfacing for anterior instability and 3 patients underwent partial re-surfacing for posterior instability. No patient had a repeat dislocation. In addition, 77% of patients in the anterior instability cohort and all of the patients in the posterior instability cohort returned to their full preinjury activity level. For the anterior instability cohort, significant improvements from preoperatively to final follow-up occurred for mean Musculoskeletal Review of System score (4.54, P<.0001) and Short Form-12 physical component score (9.52, P=.002). For the combined cohort, the Penn Shoulder Score improved by 36.4 points (P=.059). This study showed the effectiveness of partial humeral head resurfacing for preventing redislocation for patients with significant Hill-Sachs and reverse Hill-Sachs lesions. [Orthopedics. 2017; 40(6):e996-e1003.].

Open treatment of posterior glenoid bone loss and bipolar bone loss

“…Another option for severe humeral head bone defects is the HemiCAP (Arthrosurface) which was first implanted in 2004. While indicated for use in resurfacing for cases of avascular necrosis and focal post traumatic osteoarthritis, the implant has also been used in case reports for humeral bone loss in cases of anterior instability ( 56 , 57 ). This has also been used in a case of posterior instability following a fixed posterior shoulder dislocation, however further research is needed to determine outcomes following resurfacing for posterior instability ( 58 ).…”