Shoulder Resurfacing

Overview

Shoulder resurfacing is a bone-preserving surgical technique used to treat advanced arthritis or cartilage damage in the shoulder, particularly in younger or active patients. Unlike traditional total shoulder arthroplasty, which involves removing large portions of bone and inserting a stemmed prosthesis, resurfacing procedures replace only the damaged joint surfaces. This preserves bone stock, simplifies future revision surgeries, and supports faster recovery.

What Is Shoulder Resurfacing?

Shoulder resurfacing can involve:

• Humeral resurfacing: covering the damaged humeral head with a metal cap or biologic graft.
• Glenoid resurfacing: restoring the concave socket of the shoulder joint using a graft or implant.
• Total biologic resurfacing: using osteochondral allografts (from cadaveric donors) to resurface both the humeral head and the glenoid arthroscopically.

These techniques aim to relieve pain, restore motion, and delay the need for total shoulder replacement—especially critical in younger patients who face a higher risk of implant failure over time.

Indications for Shoulder Resurfacing

This procedure is particularly suited for patients who:

• Are younger than 50 years with advanced shoulder arthritis
• Have large, localized cartilage lesions or osteochondral defects
• Wish to preserve their native bone structure for future surgical options
• Are active individuals desiring quicker rehabilitation
• Have contraindications to stemmed implants due to deformities, retained hardware, or poor bone quality

Contraindications include four-part proximal humerus fractures, severe bone loss, or extensive rotator cuff damage.

Biologic Resurfacing Technique (All-Arthroscopic)

Gobezie et al. pioneered an all-arthroscopic technique that uses osteochondral allografts to biologically resurface both the humeral head and the glenoid. The entire procedure is performed through small portals in the rotator interval, sparing the subscapularis tendon and allowing for early rehabilitation.

Step-by-Step Overview

1. Joint Preparation

• The patient is positioned in a beach-chair setup under general anesthesia.
• The rotator interval is resected arthroscopically for better access.
• Standard posterior and anterior portals are created.

2. Humeral Head Preparation

• A guide pin is inserted and the humeral head is reamed retrogradely using specialized instrumentation.
• The reaming is matched to a 20–30 mm area for graft placement.

3. Glenoid Preparation

• A similar reaming process is done on the glenoid using a fresh allograft harvested from the medial tibial condyle.
• Care is taken to ensure circumferential contact between graft and host bone.

4. Graft Insertion

• The glenoid graft is press-fit and secured with chondral darts.
• The humeral graft is inserted using a suture looped through the transhumeral portal and secured over the reamed area.

Prosthetic Resurfacing Technique

Alternatively, resurfacing can be performed using metal-alloy prosthetic caps, typically made of cobalt-chromium or titanium. These caps are fitted over the reshaped humeral head without entering the medullary canal, avoiding stem-related complications.

Advantages include:

• Minimal bone resection
• Restoration of native biomechanics (inclination, version, offset)
• Easy revision if needed
• Shorter operative time

Some prostheses include glenoid components made of polyethylene or biologic grafts, while others use humeral-only (hemiresurfacing) configurations.

Postoperative Recovery

Post-surgery, the arm is immobilized briefly in a sling. Rehabilitation focuses on:

• Early passive range-of-motion exercises
• Limiting external rotation for the first 4 weeks
• Gradual return to full activities over 8–12 weeks

Patients typically experience significant reductions in pain and gains in shoulder function, often regaining substantial mobility.

Results and Long-Term Outlook

• Pain score reduced from 8.7 to 1.5
• Functional score (ASES) improved from 57 to 89
• All grafts remained stable with no resorption

In prosthetic resurfacing, studies have demonstrated:

• Comparable outcomes to stemmed arthroplasty in pain relief and motion
• Improved results in younger patients
• Easier revision if needed later in life

Patients under 55 were able to return to athletic activity including weightlifting, golf, tennis, and yoga. Elderly patients also fared well with minimal morbidity.

Risks and Considerations

Like all surgical procedures, shoulder resurfacing carries risks:

• Infection, especially with allograft material
• Graft resorption or loosening
• Disease transmission (very rare, e.g., HIV risk is <1 in a million)
• Periprosthetic fractures (extremely rare in resurfacing)
• Potential glenoid erosion in humeral-only resurfacing over time

 

Why Choose Shoulder Resurfacing?

This procedure offers a compelling alternative for younger or active patients who need shoulder intervention but wish to:

• Avoid the lifetime risk of multiple revisions
• Preserve bone stock
• Recover function quickly
• Maintain options for future conversion to total shoulder arthroplasty

With the emergence of arthroscopic biologic resurfacing, patients now have a less invasive, bone-sparing treatment that shows excellent early outcomes and promising mid-term durability.