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.
How Common It Is and Who Gets It? (Epidemiology)
Biologic shoulder resurfacing is primarily used for younger patients (under 65) with shoulder arthritis who are physically active or involved in manual labor. These patients are often at risk for faster wear of traditional shoulder replacements due to their high activity levels. Biologic resurfacing is ideal for those who want to avoid or delay a full shoulder replacement.
Why It Happens – Causes (Etiology and Pathophysiology)
The long-term wear and tear of the shoulder joint can result in arthritis, where the cartilage that lines the glenoid (shoulder socket) and the head of the humerus (upper arm bone) deteriorates. This leads to pain, stiffness, and limited range of motion. In younger individuals, this damage may be due to prior injury, chronic instability, or repetitive overhead use. Biologic resurfacing offers a solution that preserves more of the natural bone and cartilage, using a biologic graft to resurface the damaged joint.
How the Body Part Normally Works? (Relevant Anatomy)
The shoulder is a ball-and-socket joint, with the humeral head fitting into the glenoid of the scapula. The joint is stabilized by cartilage (labrum) and several ligaments. Over time, the cartilage that lines the joint can wear down, leading to arthritis and pain. Biologic shoulder resurfacing aims to replace the damaged cartilage in the glenoid without removing the entire socket or placing artificial materials like plastic or metal.
What You Might Feel – Symptoms (Clinical Presentation)
Patients with shoulder arthritis typically experience pain, especially during overhead movements or lifting activities. Other symptoms include stiffness, reduced range of motion, and occasional weakness. As the arthritis progresses, these symptoms worsen, and the pain can become chronic, significantly limiting function in daily activities or sports.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosing shoulder arthritis and determining whether biologic resurfacing is appropriate involves a clinical exam and imaging studies. X-rays and MRIs are used to assess the condition of the joint, including the extent of cartilage loss and bone damage. If arthritis is diagnosed, further imaging may be done to evaluate the suitability of biologic resurfacing, especially if a traditional shoulder replacement is being considered.
Classification
Shoulder arthritis is classified based on the degree of cartilage damage and the presence of bone changes. Mild arthritis involves some cartilage loss but no significant bone changes, while advanced arthritis includes significant cartilage degradation and joint deformity. Biologic resurfacing is typically considered in cases of moderate arthritis where the damage is limited to the cartilage surface.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can cause shoulder pain and stiffness include rotator cuff tears, SLAP lesions, and shoulder impingement syndrome. Accurate diagnosis through clinical evaluation and imaging is essential to distinguish between these conditions and arthritis.
Treatment Options
Non-Surgical Care
- Rest, ice, and anti-inflammatory medications to reduce pain and inflammation
- Physical therapy to improve strength and flexibility
- Steroid injections to manage inflammation in the joint
Surgical Care
- Biologic shoulder resurfacing, which involves replacing the damaged cartilage of the glenoid with a graft made from acellular human dermal tissue
- Hemiarthroplasty, where a metal implant is placed on the head of the humerus
- In some cases, a full shoulder replacement may be necessary if biologic resurfacing is not suitable
Recovery and What to Expect After Treatment
After biologic shoulder resurfacing surgery, patients are typically required to wear a sling for 3 weeks to protect the shoulder. Rehabilitation begins with gentle motion exercises, followed by more active rehabilitation starting at 6 weeks. Patients can expect a return to full activity, including sports and physical labor, within 3 to 6 months, depending on their individual recovery progress.
Possible Risks or Side Effects (Complications)
Possible complications include infection, graft failure, persistent pain, weakness, or the need for future surgery. Although biologic resurfacing avoids the need for metal implants, there is still a risk of joint degeneration over time. Some patients may also experience cramping or spasms in the shoulder.
Long-Term Outlook (Prognosis)
Biologic shoulder resurfacing generally provides excellent pain relief and improves shoulder function in younger patients. However, the long-term success of the procedure depends on the individual’s activity level, the quality of the graft, and adherence to post-surgery rehabilitation. In some cases, a patient may eventually need a total shoulder replacement, especially if the biologic graft does not fully integrate or if the arthritis progresses.
Out-of-Pocket Cost
Medicare
CPT Code 23470 – Biologic Shoulder Resurfacing (Shoulder Arthroplasty with Biologic Material): $282.67
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your biologic shoulder resurfacing is required due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.
No-Fault Insurance
If your shoulder resurfacing surgery is needed due to an automobile accident, No-Fault Insurance will typically cover the full cost of your treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
David Martinez underwent biologic shoulder resurfacing (CPT 23470) for advanced arthritis in his shoulder. His estimated Medicare out-of-pocket cost was $282.67. Since David had supplemental insurance through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
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.
Summary and Takeaway
Biologic shoulder resurfacing is an effective and minimally invasive solution for younger, active patients with arthritis who wish to delay or avoid traditional shoulder replacement. By using a biologic tissue graft, this procedure offers pain relief, functional improvement, and joint preservation. It is a promising option for individuals looking to maintain an active lifestyle with reduced risk of future surgeries.
Clinical Insight & Recent Findings
A recent study compared the effectiveness of T-shaped versus conventional cylinder-shaped biceps tenotomy in treating long head of the biceps tendon (LHBT) lesions, particularly in patients undergoing arthroscopic rotator cuff repair.
The study found that the T-shaped technique, which includes a portion of the superior labrum, had a significantly lower incidence of Popeye deformity (6.7% vs. 22%) and a higher success rate in preventing anatomic failure as assessed by ultrasound (11.1% vs. 31.7%). Both techniques showed significant improvements in pain and function postoperatively, with no significant differences in muscle strength or range of motion.
These results suggest that T-shaped tenotomy is a promising alternative, offering similar functional outcomes with fewer cosmetic complications compared to conventional cylinder-shaped tenotomy. (“Study on biceps tenotomy techniques – see PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons specializing in shoulder procedures and joint preservation typically perform biologic shoulder resurfacing. A rehabilitation team, including physical therapists, is essential to the recovery process.
When to See a Specialist?
Consult a specialist if you experience chronic shoulder pain that has not improved with conservative treatments, particularly if you are under 65 and active.
When to Go to the Emergency Room?
Seek emergency care if you experience severe shoulder pain following a traumatic injury or if you notice signs of infection, such as fever or redness at the surgical site.
What Recovery Really Looks Like?
Post-surgery recovery involves wearing a sling, gradually increasing range of motion and strength, and returning to daily activities within a few months. A full return to sports and physical labor may take 3 to 6 months.
What Happens If You Ignore It?
If left untreated, shoulder arthritis can lead to chronic pain, stiffness, and further damage to the shoulder, potentially requiring more invasive surgery down the line.
How to Prevent It?
Maintaining a healthy shoulder with strengthening exercises, proper technique, and avoiding repetitive overhead activities can help prevent arthritis progression.
Nutrition and Bone or Joint Health
Eating a balanced diet rich in calcium, vitamin D, and omega-3 fatty acids supports joint health and may help reduce inflammation and support healing after surgery.
Activity and Lifestyle Modifications
To prevent recurrence, patients should avoid high-risk activities that place strain on the shoulder joint. Regular exercise focusing on shoulder stability and flexibility is key to long-term joint health.
