Retrospective Analysis of Arthroscopic Management of Glenohumeral Degenerative Disease

doi:10.1016/j.arthro.2010.02.026

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 11, November 2010, Pages 1451-1455

https://doi.org/10.1016/j.arthro.2010.02.026 Get rights and content

Purpose

The purpose of this study was to examine the results of arthroscopic debridement for isolated degenerative joint disease of the shoulder.

Methods

We retrospectively identified 81 patients who had arthroscopic debridement to treat glenohumeral arthritis. Of these patients, 71 (88%) were available for follow-up. The preoperative Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, Short Form 12 score, visual analog scale score for pain, and range of motion were recorded. These were compared against postoperative scores by use of the statistical paired t test. In addition, patients completed postoperative University of California, Los Angeles; Constant; and Single Assessment Numeric Evaluation scores. Forty-six preoperative radiographs were blindly evaluated and classified. Finally, the need for subsequent shoulder arthroplasty was recorded.

Results

The mean follow-up for the 55 patients who did not progress to arthroplasty was 27 months. The mean preoperative and postoperative American Shoulder and Elbow Surgeons, Simple Shoulder Test, and pain visual analog scale scores all significantly improved (P < .05). Furthermore, range of motion significantly improved (P < .05) in flexion, abduction, and external rotation. Additional postoperative scores were as follows: University of California, Los Angeles, 28.3; Single Assessment Numeric Evaluation, 71.1; Constant score for affected shoulder, 72.0; and Constant score for unaffected shoulder, 78.5. Of the patients, 16 (22%) underwent arthroplasty at a mean of 10.1 months after debridement. Radiographic review showed that 13 shoulders with a mean joint space of 1.5 mm and grade 2.4 arthrosis went on to have shoulder arthroplasty. In contrast, 33 shoulders with a mean joint space of 2.6 mm and grade 1.9 arthrosis did not go on to have shoulder arthroplasty.

Conclusions

Patients with residual joint space and an absence of large osteophytes can avoid arthroplasty and have increased function with decreased pain after arthroscopic debridement for degenerative joint disease. Significant risk factors for failure include the presence of grade 4 bipolar disease, joint space of less than 2 mm, and large osteophytes.

Level of Evidence

Level IV, case series.

Section snippets

Methods

The study was reviewed by our institutional review board, and all patients provided informed consent. From 2001 to 2007, the senior surgeons' operative databases were reviewed based on Current Procedural Terminology coding, and 81 patients were retrospectively identified who had arthroscopic debridement for the management of glenohumeral arthritis. Of these patients, 71 (88%) were available for follow-up. The procedure was performed by 1 of 4 surgeons at a single institution. Inclusion criteria

Results

Seventy-one patients were available for follow-up and were segmented into either an arthroplasty or non-arthroplasty subset; the mean age was 47 years (range, 18 to 77 years). At final follow-up, 16 (22%) had undergone shoulder replacement at a mean of 10.1 months (range, 2.5 to 27.2 months; SD, 6.41) after debridement; 4, hemiarthroplasty; 9, total shoulder arthroplasty; and 3, humeral head allograft. The remaining 55 patients comprise the non-arthroplasty subset. There were no statistically

Discussion

The principal results of our study show that arthroscopic debridement can be a successful treatment adjunct for degenerative joint disease of the shoulder in select patients. We treated 71 patients with glenohumeral arthritis with arthroscopic debridement and followed them up at a mean of 27 months. Of these patients, 16 (22%) went on to shoulder replacement at a mean of 10 months. These patients routinely had less than 2 mm of joint space on the preoperative anteroposterior radiograph with

Conclusions

References (13)

F.A. Matsen et al.
Patient self-assessment of health status and function in glenohumeral degenerative joint disease
J Shoulder Elbow Surg
(1995)
G.M. Gartsman et al.
Self-assessment of general health status in patients with five common shoulder conditions
J Shoulder Elbow Surg
(1998)
J.Y. Bishop et al.
Management of glenohumeral arthritis: A role for arthroscopy?
Orthop Clin North Am
(2003)
D.P. Richards et al.
Arthroscopic debridement and capsular release for glenohumeral osteoarthritis
Arthroscopy
(2007)
H. Ellman et al.
Early degenerative joint disease simulating impingement syndrome: Arthroscopic findings
Arthroscopy
(1992)
D.M. Weinstein et al.
Arthroscopic debridement of the shoulder for osteoarthritis
Arthroscopy
(2000)

There are more references available in the full text version of this article.

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Citation Excerpt :
Results of arthroscopic management of glenohumeral arthritis in the literature are mixed, with some series showing improvement and others with outcomes that are more disappointing. Patients with small isolated chondral lesions or small osteophytes tend to do better than those with multifocal or larger lesions or large osteophytes.27-34 In addition to arthroscopic debridement, microfracture techniques or chondral transplant techniques have also been described in the shoulder for glenohumeral chondral defects, although there is little long term information in the literature regarding outcomes following these procedures.27,33-41,42
Interesting recent trends are apparent in the setting of shoulder and elbow pathology. There is an increase in utilization of shoulder arthroplasty for osteoarthritis and post traumatic arthritis. At the same time, there remain limited options for osteoarthritis of the elbow particularly in the young and or active patient. This manuscript details surgical options for osteoarthritis at the elbow and shoulder.
Utilization of reverse shoulder arthroplasty for the treatment of glenohumeral arthritis among American Board of Orthopaedic Surgery (ABOS) Part II candidates, 2008-2019
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Despite advances in shoulder arthroplasty, treatment options for advanced glenohumeral osteoarthritis (GHOA) remain limited. Surgical management includes total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and hemiarthroplasty. The rates of TSA and RSA for the treatment of GHOA in the United States has increased in recent years. Trends in shoulder arthroplasty in recently trained surgeons have not been explored. The purpose of the study was to examine the trends in arthroplasty use (TSA, RSA, and hemiarthroplasty) for primary GHOA among American Board of Orthopedic Surgeons (ABOS) Part II examinees, and to identify patterns based on geographic region or fellowship training.
ABOS Part II examinees with at least 1 shoulder arthroplasty in the examination years 2008-2019 were collected. Hemiarthroplasty, TSA, and RSA performed from 2007-2018 for a diagnosis of primary GHOA were included. Arthroplasty for primary or secondary diagnoses of fracture, infection, tumor, rotator cuff arthropathy or tear, revision, and non-arthroplasty procedures were excluded. Proportion and volume of cases were evaluated, with sub-analyses of geographic region and fellowship training. Univariate logistic regression determined statistical significance (P< .05).
A total of 946,946 cases from 8609 ABOS Part II examinees were submitted, with 8733 shoulder arthroplasties performed. Overall, 3923 arthroplasties for primary GHOA were included (44.9% of all shoulder arthroplasties). TSA was used in 50.9% of cases. The proportion of RSA performed for primary GHOA has increased over the past 11 years, with RSA surpassing TSA as the most common procedure for primary GHOA over the last 4 years (P< .001). Hemiarthroplasty is less commonly. TSA and RSA were performed in similar proportions across regions, with the largest volume in the Midwest. Most procedures (91.5%) were completed by surgeons in sports medicine, shoulder and elbow, and those completing multiple fellowships. From 2008-2019 the number of RSA procedures performed for primary GHOA by sports medicine and shoulder and elbow surgeons has increased approximately 1100% and 800%, respectively (P< .001).
Utilization of RSA for treatment of primary GHOA by ABOS Part II examinees has increased significantly over the past twelve years. Among ABOS Part II examinees, RSA has recently surpassed TSA as the most common arthroplasty utilized for treatment of primary GHOA. Examination of early-career surgical practice allows for consideration of training influence in treatment of GHOA. As volume of shoulder arthroplasty continues to increase, trends and procedure volume have implications for clinical practice and patient outcomes.
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Nonarthroplasty options for glenohumeral arthritis and chondrolysis
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Glenohumeral arthritis in the young and active population remains a challenge. Chondrolysis is defined as diffuse, rapid cartilage destruction with narrowing or loss of joint space. A detailed patient history, examination, and advanced imaging modalities are key to identify the etiology and to develop an individualized treatment strategy. Nonoperative treatment, including patient education, pharmacotherapy, physical therapy, and intra-articular injections should be considered before surgical options. Nonarthroplasty options aim to relieve pain, improve function, and delay time to arthroplasty with palliative, reparative, restorative, and reconstructive techniques.
Humeral Head Morphology Influences Outcomes of Arthroscopic Interposition Glenoid Patch Allograft for Glenohumeral Arthritis
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To determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head.
Patients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs.
A total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02).
Arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night.
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Arthroscopic capsular release and debridement of painful shoulder osteoarthritis can improve symptoms and delay arthroplasty: a mid- to long-term follow-up study
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In patients with symptomatic osteoarthritis of the shoulder, arthroscopic débridement, and capsular release will provide relief of symptoms and improvement in function for a minimum of 2 years.
Prospective outcome data was collected from patients who underwent arthroscopic débridement and capsular release for painful idiopathic glenohumeral arthritis from 2005 to 2013 by one surgeon. The primary outcome was conversion to shoulder arthroplasty. UCLA and Simple Shoulder Test scores were also collected by phone or mailing. Preoperative radiographs were evaluated for Samilson and Prieto classification and Walch glenoid classification.
Thirty-three of 40 patients (82.5%) who met inclusion criteria with an average time since surgery of 6.4 years (range, 2-10 years) were reached for final follow-up. Eight of 33 respondents (24.2%) had conversion to arthroplasty within the study period at an average 1.75 ± 2.37 years (range, 0.5-7 years) postoperatively. Nine patients (36%) reported no pain at the time of survey. Of patients who reported current pain (16/25, 64%), 7 (43.7%) had improved pain since surgery. For patients with preoperative UCLA scores, scores were significantly higher at mid-term (P = .003) and long-term (P =0.017) follow-up. Patients who were less than 8 years since surgery had significantly higher SST (2-4 years, P =0.004; 5-7 years, P = .024) and UCLA (2-4 years, P = .004; 5-7 years, P = .011) scores than those who were 8-10 years since surgery. There were no significant differences in preoperative radiographic classifications and outcome.
Arthroscopic débridement with capsular release in certain patients with osteoarthritis of the shoulder can provide long-term pain reduction, increased function, and can delay shoulder arthroplasty.
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Original ArticleRetrospective Analysis of Arthroscopic Management of Glenohumeral Degenerative Disease

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Orthop Clin North Am

Arthroscopy

Arthroscopy

Arthroscopy

Original Article
Retrospective Analysis of Arthroscopic Management of Glenohumeral Degenerative Disease