Although treatment options are available in elderly patients with shoulder arthritis, they are limited in young patients. In a recent review, Jonathan D. Barlow, MD, Shoulder and Elbow Surgeon, Department of Orthopaedics, The Ohio State University, Columbus, and Joseph Abboud, MD, Shoulder and Elbow Surgeon, Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, discussed ongoing diagnostic and treatment challenges, including surgical options in young patients with glenohumeral arthritis.
“Thorough history, physical, and radiographic analysis is paramount to distinguish possible secondary causes of arthritis, as well as to prepare for potential surgical management,” the study authors explained. “Nonoperative management is the mainstay of treatment of shoulder arthritis in this population.”
A Variety of Population Groups
There are several different populations of young patients with glenohumeral arthritis. In particular, some patients may have an underlying diagnosis of chondrolysis. It is characterized by rapid loss of articular cartilage from the humerus and glenoid, in the absence of osteophyte formation. These cases have been reported at an alarming rate, Dr Barlow and Dr Abboud report, and chondrolysis is currently the focus of research. Inflammatory arthritis has been reported in the literature as another potential cause of glenohumeral arthritis.
Young patients with glenohumeral arthritis and recurrent shoulder instability are one population of patients that present a challenge. Arthroscopy and open Bankart tend to have better long-term outcomes than other surgical interventions, such as Putti-Platt and Eden-Hybbinette.
The authors also discuss in detail other groups of patients with glenohumeral arthritis who may present with osteonecrosis, glenoid dysplasia, or osteoarthritis.
Considerations When Evaluating Patients
When performing workups in young patients with arthritis, the authors recommend starting with a thorough history of the patient, as well as a physical examination. Focus should also be placed on distinguishing glenohumeral arthritis pain versus other shoulder pains (eg, acromioclavicular joint, rotator cuff, and labral pathology), by asking patients about the quality and timing of the shoulder pain, as well as aggravating factors.
Patients should also be asked about other aspects of their medical history, including previous steroid use, sickle cell disease, and alcohol use.
Radiographic imaging should be a part of patients’ evaluations, including preoperative anterior posteriors with internal and external rotations, and axillary views. The authors also suggest that axial imaging can be helpful in young patients with complex histories and who have had previous operations.
Ruling out infection in patients with a history of previous surgeries and atypical presentation is critical, and can be done by performing complete blood cell counts, erythrocyte sedimentation rates, and C-reactive protein laboratory studies, Dr Barlow and Dr Abboud emphasized.
In general, the authors of the review recommend nonoperative treatment, such as physical therapy and anti-inflammatory medication when indicated, as the initial choice for young patients with glenohumeral arthritis. Corticosteroid injections, hyaluronic acid injections, and platelet-rich plasma may be considered if these treatment modalities are unsuccessful. Arthroscopic debridement, hemiarthroplasty, and total shoulder arthroplasty should be considered in young patients with shoulder arthritis if nonoperative options fail.
Dr Barlow and Dr Abboud discuss in detail the different surgical options for this patient population, one of which is glenohumeral debridement, which is used to preserve the joint, and allows the surgeon to assess the joint surfaces and rotator cuff directly. Arthroscopic resurfacing arthroplasty is another option for young patients with shoulder arthritis. It is considered an intermediate option, between arthroscopic debridement and hemiarthroplasty.
The authors also discuss the use of hemiarthroplasty and resurfacing hemiarthroplasty in specific subpopulations, as well as hemiarthroplasty with glenoid reaming, hemiarthroplasty with biologic interposition, newer resurfacing, and bipolar biologic resurfacing.
- Barlow JD, Abboud J. Surgical options for the young patient with glenohumeral arthritis. Int J Shoulder Surg. 2016;10:28-36.