Sauramps Medical Shoulder Concepts - Arthroplasty For The Young Arthritic Shoulder

Finding the right treatment for a young patient (< 60 years) with glenohumeral osteoarthritis is still a challenge. In case of failure of conservative therapy, surgical treatment must be considered. The indications for a surgical treatment depend not only on the radiological findings but also on the explicit age of the patients, their occupation, activity level, duration of symptoms, comorbidities and concomitant shoulder pathology. Arthroscopic management of glenohumeral arthritis includes capsular release, removal of loose bodies, subacromial decompression, axillary nerve neurolysis, biceps tenodesis, chondroplasty, microfracturing, and humeral osteophyte resection. This can result in pain relief, but usually does not improve shoulder motion. However, these effects are temporary and results are unpredictable. Furthermore, these techniques do not provide a definitive solution for advanced-stage glenohumeral arthritis. Osteotomy or bone graft in case of glenoid dysplasia has yielded disappointing results as well. Today, an unacceptable compromise in quality of life may constitute a valid indication for shoulder replacement in young patients who seek so-called “high-performance shoulders” to attain their expectations and aspirations. Initial pain relief and functional improvement are usually excellent after shoulder arthroplasty; however, these gains are short-lived in the younger population, with a dramatic decline in functional outcome and survival rate at mid- to long-term follow-up. The concerns about shoulder arthroplasty in this population are mainly due to the higher demands on the operated shoulder, the higher expectations regarding the surgical result, and the longevity of the prosthetic shoulder due to increased life expectancy. Younger patients who receive a total shoulder arthroplasty have a higher rate of glenoid component loosening and rotator cuff tears, likely related to higher activity levels, and therefore, alternative strategies have been sought...