Stemless Humeral Prosthesis and Meniscal Allograft: Should We Abandon This Technique?
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Published:
Aug 29, 2025
Keywords:
Prosthesis, humeral head, osteoarthritis, allograft, meniscus, hemiarthroplasty
Main Article Content
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, thesame 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.
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, thesame 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.
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How to Cite
Caloia, M., Chamorro, G., González Scotti, D., Caloia, H., Ronconi, S. E., Meritano, A., Serur, M. E., & Davies, A. (2025). Stemless Humeral Prosthesis and Meniscal Allograft: Should We Abandon This Technique?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(4), 310-325. https://doi.org/10.15417/issn.1852-7434.2025.90.4.2046
Section
Clinical Research
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References
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10. Lee BK, Vaishnav S, Hatch III GFR, Itamura JM. Biologic resurfacing of the glenoid with meniscal allograft: longterm results with mínimum 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 followup. J Shoulder Elbow Surg 2024;33(2):328-34. https://doi.org/10.1016/j.jse.2023.06.021
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: longterm results with mínimum 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 followup. J Shoulder Elbow Surg 2024;33(2):328-34. https://doi.org/10.1016/j.jse.2023.06.021