ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1720

 

Five-Year Outcomes of Powerlifters and Bodybuilders Undergoing Stemless Aspherical Humeral Head Resurfacing along with an Inlay Glenoid

Luis A. Vargas, MD, PhD, Coral Gables, FL UNITED STATES
John W. Uribe, MD, Coral Gables, FL UNITED STATES
John E. Zvijac, MD, Coral Gables, FL UNITED STATES
Keith S. Hechtman, MD, Coral Gables, FL UNITED STATES
David A. Porter, MD, Coral Gables, FL UNITED STATES

Miami Orthopedic Sports Medicine Institute, Coral Gables, FL, UNITED STATES

FDA Status Cleared

Summary

Symptomatic glenohumeral arthritis (GHA) among high-level bodybuilders and powerlifters is relatively common. Once conservative management fails, the surgical options for these athletes are limited.Stemless aspherical humeral head resurfacing combined with inlay glenoid replacement provides substantial pain relief and functional improvement and is a promising option for the management of symptoms

Abstract

Introduction

Symptomatic glenohumeral arthritis (GHA) among high-level bodybuilders and powerlifters is relatively common. Once conservative management fails, the surgical options for these athletes are limited and pose challenges due to their relatively young age and tremendous muscle mass with little compressive body fat. The benefits of arthroscopic management are limited and short-lived. Total shoulder arthroplasty remains controversial, is technically more difficult, and glenohumeral stresses upon return to even moderate lifting present an added risk for failure.

A series of competitive or high-level recreational bodybuilders and powerlifters with advanced GHA who expressed a strong desire to continue their sport were managed utilizing a novel stemless aspherical resurfacing of the humeral head (HHR) combined with an inlay glenoid (IG). To our knowledge, there are no published studies documenting the efficacy of this unique approach.

Materials And Methods

Our series consists of 9 male athletes with an average age of 45.6 years (range 25-57) who were prospectively followed. Pre- and postoperative evaluations included physical examination, radiographic assessment, the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, the Western Ontario 0steoarthritis of the Shoulder Index (WOOS), pain visual analog scale (VAS-P), forward flexion (FF),external rotation (ER), internal rotation (IR) and patient satisfaction rating.

Results

No intraoperative complications were encountered, no blood transfusions were required, and all procedures were performed on an outpatient basis. The mean follow-up was 31 months (range 16-51). The mean ASES score improved from 26 to 93, and the mean WOOS score improved from 18 to 87. The mean VAS-P decreased from 9 to 1, mean FF increased from 115° to 135°, mean ER improved from 30 ° to 60° and IR improved from the level of the sacrum to L3. eight of the nine patients rated their preoperative shoulder satisfaction as poor; at last follow-up, all patients rated their shoulder as good to excellent. Radiographic follow-up revealed no evidence of component loosening, glenoid migration, or evidence of device failure. All patients were satisfied with the procedure and 8 / 9 returned to a moderate or higher level of weight lifting activities. One patient required an arthroscopic capsular release for arthrofibrosis which significantly improved function.

Conclusion

Stemless aspherical humeral head resurfacing combined with inlay glenoid replacement provides substantial pain relief and functional improvement and is a promising option for the management of symptomatic osteoarthritis in this challenging patient population. The procedure allows for a return to activities without restrictions and leaves multiple arthroplasty options if revision becomes necessary. Our results need to be reconfirmed in a larger cohort with longer follow-up.