Arthroscopic Biologic Total Shoulder Resurfacing is an innovative technique developed by Dr. Chudik that restores the joint surfaces of the arthritic shoulder using cadaver cartilage delivered through small arthroscopic incisions. The procedure preserves the rotator cuff and avoids the dislocation step required by traditional shoulder replacement. While the technique remains under research and is not yet routinely available, it represents a less invasive option for selected patients with shoulder arthritis who would benefit from joint preservation.
What Is Arthroscopic Biologic Total Shoulder Resurfacing?
Glenohumeral arthritis occurs when the protective cartilage covering the humeral head (ball of the upper arm bone) and glenoid (socket of the shoulder) wears out from joint loading over time, often in genetically susceptible patients or following injury. The currently established surgical treatment is total shoulder arthroplasty, in which the worn surfaces are replaced with metal and plastic components.
Arthroscopic Biologic Total Shoulder Resurfacing approaches the same problem differently. Rather than replacing the joint surfaces with metal and plastic, the technique resurfaces them with cadaver-donor cartilage. Rather than open surgery, the procedure is performed entirely through small arthroscopic incisions. Rather than detaching and repairing the rotator cuff for joint access, the rotator cuff is preserved intact. The shoulder is not dislocated during the procedure.
The procedure is offered as an outpatient procedure or 23-hour overnight stay, with general anesthesia and an interscalene nerve block.
Development Rationale
Traditional total shoulder arthroplasty has reliable outcomes but requires significant surgical disruption: an open incision, detachment of the subscapularis tendon, dislocation of the joint, and replacement of the native joint surfaces with artificial components. The recovery is governed by the time required to heal the rotator cuff repair and protect the implant during early motion.
Dr. Chudik developed Arthroscopic Biologic Total Shoulder Resurfacing to address several limitations of conventional shoulder replacement:
- A less invasive approach without the open incision and soft-tissue disruption
- Better restoration of the patient’s native anatomy
- No need to cut and repair rotator cuff muscles to access the joint
- No requirement to dislocate the joint during surgery
- Preservation of native bone for future surgical options
The procedure is currently in research and is not yet commonly available. Survivorship of the transplanted cartilage and the predictability of long-term pain relief are still being evaluated. For older patients with established arthritis, a traditional shoulder replacement with artificial surfaces remains superior at this stage of development.
Who Is a Candidate?
Candidates for Arthroscopic Biologic Total Shoulder Resurfacing are evaluated on a case-by-case basis given the procedure’s investigational nature. Considerations include:
- Glenohumeral arthritis with worn cartilage surfaces appropriate for resurfacing
- Younger or active patients who may benefit from joint preservation versus traditional replacement
- Adequate rotator cuff function
- Willingness to commit to a six-week sling immobilization and a four-month physical therapy program
- General health sufficient for safe surgery
- Realistic expectations about the procedure’s investigational status
Contraindications include infection, inability to complete the postoperative program, and poor general health.
How the Procedure Is Performed
Using small incisions and arthroscopic portals, Dr. Chudik visualizes the shoulder joint with a miniature camera. Through the same incisions, the worn surfaces of the humeral head and glenoid are prepared with specialized instruments. Cadaver-donor cartilage is then delivered into the joint and attached to the prepared bone surfaces, restoring smooth articulation.
Because the entire procedure is arthroscopic, the rotator cuff is not violated. There is no subscapularis takedown to repair, and no dislocation step. This preserves the soft-tissue envelope of the joint and allows recovery to focus on the cartilage transplant rather than rotator cuff healing.
Recovery and Rehabilitation
Recovery follows a protected protocol designed to allow the transplanted cartilage to heal:
- Sling protection at all times for six weeks except for bathing, dressing, and supervised exercises (this prohibits driving)
- No active movement of the surgical shoulder for at least six weeks to protect the cartilage during healing
- Sleeping upright on a couch or recliner is often more comfortable in the early weeks
- Wound care: keep clean and dry for three days; light showering after three days; no submersion under water for three weeks
- Driving typically resumes at six to eight weeks
- Return to school or sedentary work in one to two weeks while in the sling, with no use of the affected arm
- Physical therapy begins two to three days after surgery and continues for four months
Return to activity typically requires four to six months and depends on progress in physical therapy and the demands of the intended activities. Full shoulder motion and strength must be restored before return to demanding activities. Dr. Chudik has special protocols for return to golf and other recreational activities.
Risks and Outcomes
Specific surgical risks include:
- Infection
- Bleeding
- Rejection of biological implants
- Rare nerve injury producing numbness, weakness, or paralysis of the shoulder and arm
- Persistent stiffness or loss of motion
- Moving or breaking of surgical hardware
- Failure of the transplanted bone and cartilage
- Need for revision surgery, including conversion to traditional total shoulder arthroplasty
Survivorship of the transplanted cartilage and the durability of pain relief are not yet predictable. Research trials are in progress, and the procedure is not yet commonly available. For most older patients, traditional shoulder replacement with artificial components remains the more reliable option at this time.
Why Dr. Chudik for Arthroscopic Biologic Total Shoulder Resurfacing
Dr. Chudik developed the arthroscopic biologic resurfacing technique as part of his ongoing research into less invasive joint preservation surgery. He performs the procedure in selected patients who meet investigational criteria and discusses whether the technique is appropriate for an individual case alongside traditional and reverse arthroplasty options. Patients who are evaluated for this procedure receive a candid discussion of its current research status and the alternatives that have established long-term outcomes.