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Wimbledon Clinics
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December 10, 2018

Shoulder arthritis: arthroscopic management can help avoid joint replacement

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Arthroscopic management of shoulder arthritis can help patients avoid or delay total shoulder replacement, a new review article confirms.

In particular, it's a promising option for young, active patients diagnosed with primary glenohumeral osteoarthritis (GHOA), a common type of painful and debilitating shoulder osteoarthritis (OA), the authors explain in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

People with shoulder arthritis feel pain in the joint and may have trouble throwing, swimming and lifting their arms to do everyday tasks. Non-surgical treatments include physical therapy, home exercise, steroid injections, and anti-inflammatory medications such as ibuprofen. If these treatments don't provide sufficient relief, the next steps may include removing damaged cartilage or bone or arthroplasty (surgical reconstruction or replacement of the joint).

"Total shoulder replacement is not ideal for young, high-demand patients with GHOA," said Dr Peter J. Millett, lead author of the study and orthopaedic surgeon at the Steadman Clinic in Colorado. "Instead patients under 50 years old or select active patients up to age 65 with advanced GHOA who haven't experienced adequate relief from non-surgical treatment may experience the greatest benefit from arthroscopic management."

A treatment approach known as Comprehensive Arthroscopic Management (CAM), developed by Dr Millett and his colleagues, preserves the shoulder joint, decreases pain and improves function.

"The CAM procedure is a minimally invasive surgery that removes mechanical irritants from the joint, reshapes the humerus to make it round again and also to decrease any impingement on the adjacent nerves," Dr Millett explained. "The overall goal is to achieve a synergistic benefit with pain relief and functional restoration, without burning bridges for future surgeries, all while delaying joint replacement or perhaps even avoiding it altogether."

According to the review article, outcomes for patients with advanced symptomatic GHOA who underwent CAM procedures include:

- Significantly improved ability to complete daily activities and reduced pain and instability as reported by both patients and doctors;

- Significant rates of preventing total shoulder arthroplasty (TSA) at one, two, three and five years following CAM procedures; and

- Median patient satisfaction rate of nine out of 10 five years after CAM procedures among patients who did not need TSA.

Long-term outcomes remain unknown, and there is no guarantee a patient will not need arthroplasty in the future, but overall the data looks promising.

http://newsroom.aaos.org/media-resources/Press-releases/patients-with-shoulder-arthritis-have-new-options-to-avoid-risks-of-total-shoulder-replacement.htm

https://journals.lww.com/jaaos/Abstract/2018/11010/Arthroscopic_Management_of_Glenohumeral_Arthritis_.1.aspx

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