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Shoulder

Arthroscopic Treatment of Glenohumeral Osteoarthritis

I have shoulder arthritis. Can I consider an arthroscopic procedure to avoid shoulder replacement?

Young, highly active patients with heavy physical demands can commonly be affected by shoulder (glenohumeral) osteoarthritis. There are several alternatives to shoulder replacement in this subset of patients, but the procedures are less predictable and have limited durability in relief. So-called comprehensive arthroscopic management includes cleaning (debridement) of the joint and smoothing of irregular cartilage surfaces (chondroplasty), removing inflamed debris (synovectomy), removing loose portions of worn cartilage (loose body removal), spur (osteophyte) removal, decompression of the bones around the rotator cuff (acromion and coracoid), release of the ligaments (capsule) to improve motion, and biceps tenodesis. This procedure has some evidence it can reduce pain, improve function, and provide joint preservation in patients looking to postpone shoulder arthroplasty(1).

Studies show that in appropriately selected patients, good long term outcomes can be maintained at 10 years following arthroscopic management for shoulder arthritis(2). However, a substantial fraction of patients initially satisfied with arthroscopic treatment will progress to total shoulder replacement several years following the arthroscopic approach. Factors predicting an unfavorable outcome with arthroscopic treatment include flattening or changes in appearance of the humeral ball, and shifting and erosion of the glenoid socket, which can typically be diagnosed on standard radiographs. The ideal patient for arthroscopic treatment includes a relatively young, highly active patient with reasonably preserved radiographic (X-ray) joint congruity, preserved motion, and expectations that include improvement yet possibly not eradication of pain.

No, patients who undergo arthroscopic treatment for glenohumeral osteoarthritis and then proceed to shoulder replacement in the future have very similar benefits as those individuals opting directly for total shoulder replacement(3). Both groups of patients have nearly identical improvements in pain, function, and satisfaction rates with their shoulder replacement, which remains the gold standard for failed treatments for shoulder arthritis, including prior arthroscopy.

When treating for a shoulder condition, especially a common yet complex one with many treatments such as glenohumeral osteoarthritis, it is recommended you consider a specialist that offers the entire spectrum of treatments, including nonsurgical ones such as injections, biologics and platelet rich plasma, arthroscopy, and total shoulder replacement. Choosing a specialist that performs a high volume of each of these interventions ensures a degree of technical proficiency and no bias of decision-making, as is frequently the case with specialists not fellowship trained in the shoulder, or those offering only expensive injectables, for example. You can rest assured that should you choose to treat with shoulder surgeon Dr. Obermeyer you will have an unbiased assessment of your prognosis with each option and ensure you are comfortable with your ultimate treatment decision.


References

  1. Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive Arthroscopic Management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Arthroscopy. 2013 Mar;29(3):440-8. doi: 10.1016/j.arthro.2012.10.028. PMID: 23544687.
  2. Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive Arthroscopic Management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Arthroscopy. 2013 Mar;29(3):440-8. doi: 10.1016/j.arthro.2012.10.028. PMID: 23544687.
  3. Nolte PC, Elrick BP, Arner JW, Ridley TJ, Woolson TE, Tross AK, Midtgaard KS, Millett PJ. Total Shoulder Arthroplasty After Previous Arthroscopic Surgery for Glenohumeral Osteoarthritis: A Case-Control Matched Cohort Study. Am J Sports Med. 2021 Jun;49(7):1839-1846. doi: 10.1177/03635465211006479. Epub 2021 Apr 29. PMID: 33914650.
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Dr. Thomas Obermeyer

  • 15+ years of training and experience treating complex shoulder and sports medicine conditions
  • Expert subspecialized and board-certified orthopedic care
  • Award-winning outstanding patient satisfaction scores
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