Surgical Treatment for Glenohumeral Arthritis in the Young Patient

Osteoarthritis of the shoulder in the young patient may prove to be quite a dilemma. In patients with recalcitrant degenerative disease of the shoulder that fail nonoperative treatment, total shoulder arthroplasty has been the gold standard for treatment. These patients with primary or secondary glenohumeral arthritis may not always be ideal candidates for shoulder replacement due to age or associated pathology. Sperling et al showed that patients under the age of 50 years had long-term pain relief and improved motion following hemiarthroplasty or total shoulder arthroplasty. When a rating system was applied, however; more than half had an unsatisfactory result. There has not been agreement on whether hemiarthroplasty or total shoulder arthroplasty is the best option. Studies have demonstrated a better result following total shoulder arthroplasty compared with hemiarthroplasty with regards to motion, pain relief, and need for revision surgery. Reports of glenoid loosening are a concern in young patients. Burkhead reported a technique of humeral head replacement with resurfacing of the glenoid with a fascia lata soft tissue graft. His results in 6 patients with 2 year follow-up were 5 excellent results and 1 good result. However, long term results have not been reported. Many younger and even older patients may wish to delay shoulder arthroplasty. Arthroscopic management for early stages of osteoarthritis in young individuals has been shown to provide short term pain relief even in the presence of grade IV osteochondral lesions. Arthroscopic procedures for arthritis include debridement and irrigation, loose body removal, chondroplasty or abrasion of the glenoid and humeral head, synovectomy, and capsular release. Weinstein et al demonstrated 92% satisfaction in patients following arthroscopic debridement. These patients had a congruent joint, maintenance of joint space, and did not typically demonstrate familiar osteoarthritic radiographic changes. Results did deteriorate with time in 24% of patients. They did not advocate arthroscopy for the management of shoulders with advanced osteoarthritic changes.