Christopher C. Schmidt, MD, a board-certified orthopedic shoulder surgeon who practices in Pittsburgh, Pennsylvania, performs extensive research on the treatment of osteoarthritis and other shoulder conditions. In 2019, he shared his latest insights on shoulder arthroscopy with his peers as an invited speaker at the 6th Masterclass in Arthroplasty Surgery in Thessaloniki, Greece, where he gave a presentation entitled “Treatment of Osteoarthritis in the Young Patient (>55).”
What Is Osteoarthritis of the Shoulder?
Glenohumeral (shoulder) osteoarthritis causes a breakdown of the articular cartilage in the shoulder joint. A smooth tissue that covers the humeral head (ball) and the glenoid (socket), which come together to form the shoulder joint, articular cartilage allows the bones to glide over each other with minimal friction during movement. As the articular cartilage in the shoulder joint deteriorates, bone-on-bone contact can begin to occur, leading to pain and stiffness that can potentially interfere with activities that involve moving the shoulder or lifting the arm.
Commonly associated with degenerative changes that occur during the natural aging process, shoulder osteoarthritis can also result from—or its onset may be hastened by—an injury or trauma, such as a shoulder joint dislocation. Also, in some cases, osteoarthritis is hereditary. Therefore, the condition can affect people of all ages.
How Is Shoulder Osteoarthritis Treated?
In most cases, osteoarthritis treatment begins conservatively, regardless of the patient’s age. Non-operative alternatives to shoulder surgery include physical therapy, activity modifications, nonsteroidal anti-inflammatory drugs (NSAIDs), cortisone injections, and hyaluronic acid injections. For a patient who does not experience sufficient symptom relief after several weeks of nonsurgical treatment, surgery is a potential next step.
The surgical treatment options for glenohumeral osteoarthritis may include:
- Arthroscopic debridement
- Hemiarthroplasty (the surgical replacement of the humeral head only, leaving the glenoid intact)
- Humeral head resurfacing
- Hemiarthroplasty with glenoid resurfacing
- Total shoulder arthroplasty (glenohumeral joint replacement)
- Reverse total shoulder arthroplasty
Over the years, shoulder arthroplasty (total shoulder joint replacement) has helped many patients age 55 and older find relief from pain associated with shoulder osteoarthritis and regain function. Additionally, recent research breakthroughs have led to significant improvements in surgical techniques and implant longevity, ultimately leading to faster recoveries and better functional outcomes. As a result, total shoulder replacement is now considered to be the gold standard for the surgical management of advanced glenohumeral osteoarthritis in older patients.
The Challenges of Treating Osteoarthritis in Younger Patients
Traditionally, young and active patients with glenohumeral osteoarthritis were not considered to be good candidates for shoulder arthroplasty. Despite tremendous scientific advances that have vastly improved shoulder arthroplasty in recent years, the treatment of shoulder osteoarthritis in younger patients remains challenging for several reasons. For instance, as compared to their older counterparts, younger patients are more likely to have:
- Higher expectations regarding the outcome of surgical treatment
- A higher functional demand
- A greater degree of physical impairment prior to surgery
- Propionibacterium acnes, a skin condition that can increase the risk of infection after shoulder surgery
- Increased longevity (and therefore an increased likelihood of requiring revision surgery)
- At least 10 more years in the workforce
For these reasons, when considering surgical treatment approaches for advanced glenohumeral osteoarthritis in a younger patient, it is essential to balance multiple factors, including the patient’s expectations regarding postoperative function, desired activity level, and rotator cuff integrity. It is also important to take into account the underlying cause of the osteoarthritis, if known, as well as any predisposing factors.
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