Shoulder arthritis can be particularly difficult to manage in young, active individuals. These patients often want to remain physically active, whether for work, sports, or personal lifestyle. Unfortunately, traditional total shoulder replacements can wear out more quickly in younger patients due to their higher activity levels. This wear may lead to loosening of implants and the need for additional surgeries over time.
Because of these concerns, orthopedic surgeons have developed an alternative solution—biologic shoulder resurfacing. This technique aims to preserve more of the natural shoulder while relieving pain and improving function.
What Is Biologic Resurfacing?
Biologic resurfacing is a surgical method that replaces the damaged cartilage surface of the shoulder socket (the glenoid) using a biologically compatible material instead of metal or plastic. In this technique:
- The upper arm bone (humerus) receives a metal implant on its head (this is called a hemiarthroplasty).
- The shoulder socket (glenoid) is resurfaced using a graft made from acellular human dermal tissue—a cleaned, processed human tissue that encourages healing and tissue growth.
- This graft is soaked in platelet-rich plasma (PRP) before being implanted to promote natural healing and integration with the patient’s own tissue.
Who Is a Candidate?
This procedure is especially suited for:
- Younger patients (under 65) with shoulder arthritis
- Those who are physically active or perform manual labor
- Individuals with arthritis caused by prior injury, surgery, or chronic instability
- Patients who wish to avoid the long-term risks of a full shoulder replacement
How the Surgery Is Performed
The surgery involves several key steps:
- Positioning and Access: The patient is placed in a sitting position (called the beach chair position), and the surgeon makes an incision to access the shoulder.
- Humerus Preparation: The head of the humerus is reshaped, and a metal implant is placed.
- Glenoid Preparation:
- The glenoid surface is carefully cleaned.
- Small holes are drilled into the bone to encourage bleeding and healing.
- If needed, sutures or anchors are placed to hold the graft in position.
- Graft Insertion:
- A soft, flexible graft made from donor skin tissue is folded and sewn into shape.
- This graft is soaked in PRP to boost healing.
- The graft is securely stitched into the glenoid, forming a new, smooth surface for joint movement.
- Reconstruction: The shoulder is reassembled, ensuring stability and smooth motion.
Postoperative Recovery
After surgery, patients:
- Wear a sling for 3 weeks
- Begin gentle motion exercises immediately
- Start more active exercises by 6 weeks
- Return to full activities (including sports or physical work) between 3 and 6 months, based on individual recovery progress
This approach helps reduce stiffness and promotes a return to normal function.
Patient Results
Most patients who undergo this procedure report:
- Significant reduction in pain
- Better shoulder function and movement
- High satisfaction with the outcome
- Willingness to undergo the procedure again if needed
Even though some patients showed joint space narrowing on follow-up X-rays, their clinical function remained good. This suggests that the biologic graft doesn’t need to maintain perfect spacing to be effective in reducing pain and preserving mobility.
Why Not Just Get a Full Shoulder Replacement?
Total shoulder replacement (TSA) is often avoided in younger patients due to:
- Increased risk of wear and tear over time
- Possibility of multiple revision surgeries
- Risk of implant loosening
Biologic resurfacing avoids placing a plastic socket component, which is often the first part to fail in TSA. Instead, the patient gets a more natural joint surface that can still function effectively, even if some wear occurs over time.
Does It Always Work?
While the results are promising, it’s important to know:
- A small number of patients may still need a total shoulder replacement later.
- Some may experience shoulder pain due to other causes, like tendon irritation or impingement, which can often be managed without further surgery.
- The quality of the surgical technique and patient selection are critical to success.
In the study by Dr. Lo and colleagues, only about 9% of patients required a second surgery (a full shoulder replacement), and 81% were satisfied with their outcome. Notably, those who started with better shoulder function and had secure graft fixation tended to do best.
How This Approach Is Different
Compared to other biologic resurfacing methods, this approach uses:
- A thicker, folded graft to better cushion the joint
- Drilled holes in the glenoid to improve healing
- Platelet-rich plasma (PRP) to biologically enhance graft integration
- Secure fixation using suture anchors, especially in areas where the labrum (rim of the socket) is weak or missing
This meticulous approach may help explain why patients in this study had better outcomes than in some other reports.
Final Thoughts for Patients
Biologic shoulder resurfacing is a thoughtful and tissue-preserving option for younger, active patients with arthritis who want to avoid or delay a full shoulder replacement. It offers pain relief and restored motion while leaving the door open for future options if needed.
If you’re a candidate, this could be a way to regain shoulder function and maintain your active lifestyle—with less risk of needing multiple future surgeries.
Do you have more questions?
Q. What is biologic shoulder resurfacing?
A. Biologic shoulder resurfacing is a procedure where damaged joint surfaces are replaced with a biologic material like a graft, instead of a metal or plastic implant.
Q. Who is a candidate for biologic shoulder resurfacing?
A. Younger patients with shoulder arthritis and intact rotator cuff tendons who wish to delay a traditional joint replacement may be good candidates.
Q. What materials are used in biologic shoulder resurfacing?
A. Materials commonly used include human dermal allograft or Achilles tendon allograft.
Q. How is biologic shoulder resurfacing different from a total shoulder replacement?
A. Biologic resurfacing preserves more of the patient’s native bone and does not use metal or plastic implants, making it a more conservative approach.
Q. What are the benefits of biologic shoulder resurfacing?
A. The benefits include pain relief, preservation of bone, and the possibility to delay a traditional shoulder replacement.
Q. What is the recovery process after biologic shoulder resurfacing?
A. Recovery includes sling immobilization followed by physical therapy, with gradual return to daily activities over several weeks to months.
Q. How successful is biologic shoulder resurfacing?
A. It can be successful in the right patients, but outcomes vary and some may eventually require conversion to a total shoulder replacement.
Q. What is the purpose of using allograft tissue in this procedure?
A. Allograft tissue is used to resurface the joint surface and reduce pain while preserving bone.
Q. Can biologic shoulder resurfacing be done arthroscopically?
A. It is typically performed through an open surgical approach.
Q. What are the risks associated with biologic shoulder resurfacing?
A. Risks include infection, graft failure, persistent pain, and the need for future surgery.
Q. How long does biologic shoulder resurfacing last?
A. Longevity varies depending on the patient and activity level; some may eventually need further surgery.
Q. Is biologic shoulder resurfacing covered by insurance?
A. Insurance coverage depends on the policy and clinical necessity, and patients are encouraged to check with their provider.
