Degenerative disease of the glenohumeral joint can cause significant pain and disability. Although surgical treatment with prosthetic replacement has been used with excellent success in the elderly, management in younger patients, especially those with high physical demands, remains controversial. The initial management of these patients consists of physical therapy, injections, activity modification, or a combination. Surgery is indicated when these conservative measures fail to sufficiently alleviate symptoms.
Surgical decision making involves consideration of various nonprosthetic and prosthetic treatments. Although total shoulder arthroplasty (TSA) reliably ameliorates symptoms and improves shoulder function, this treatment option may lead to component wear, component loosening, and the need for multiple revisions in young patients. Although hemi-arthroplasty (HA) may be more attractive to young patients, this technique provides significantly less pain relief and functional improvement than does TSA.
HA with biologic glenoid resurfacing (HA þ BR) was introduced as an alternative to TSA in younger active patients with glenohumeral arthritis. A number of tissue sources have been used to resurface the glenoid in conjunction with HA, including fascia lata autograft, anterior capsule, lateral meniscus allograft, and Achilles tendon allograft. HA with concentric glenoid reaming, also known as ream and run (R & R), avoids potential concerns about the durability of soft tissue interposition. Arthroscopic debridement (AD) represents a joint-preserving approach that also effectively addresses symptom-producing pathologic conditions aside from the degenerative disease, including loose bodies, biceps tenosynovitis, and disease of the glenoid labrum or rotator cuff, or both. This strategy can be supplemented with one or more arthroscopic procedures, including chondroplasty, capsular release, subacromial decompression, and biceps tenotomy or tenodesis.
The objective of this review was to compare clinical and radiological outcomes across nonbiologic surgical treatment options for glenohumeral arthritis in patients younger than 60 years. It was hypothesized that TSA and AD would provide outcomes superior to other available techniques.