Date Published: March 27, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Olivier A. van der Meijden, Trevor R. Gaskill, Peter J. Millett.
The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement. Several palliative and restorative techniques are currently optional. Joint debridement has shown good results and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems promising when humeral osteophytes are present. Currently, microfracture seems the most studied reparative treatment modality available. Other techniques, such as autologous chondrocyte implantation and osteochondral transfers, have reportedly shown potential but are currently mainly still investigational procedures. This paper gives an overview of the currently available joint preserving surgical techniques for glenohumeral osteoarthritis.
Osteoarthritis (OA) is the most frequent cause of disability in the USA . It is suggested that as many as 50 million adults suffer from this gradual, progressive joint failure . The prevalence of OA increases with age, typically manifesting after the sixth decade of life, and women appear to be more susceptible than men . Though less prevalent than OA of the knee and hip, OA of the shoulder (Figure 1) can be equally debilitating .
Like other diarthrodial joints, the glenohumeral articular surfaces are similarly covered with hyaline cartilage which on the glenoid side is thicker at the periphery than centrally. By contrast, the humeral articular cartilage thickness is exactly the opposite; the cartilage thickness at the periphery is approximately 1 mm, increasing from 1.2 to 1.3 mm at the center of the humeral head . It is thought that this variation in cartilage thickness may increase the congruency of the joint’s osseous structures .
The management of osteochondral pathology of the shoulder in young active patients is a challenge, and the optimal treatment has yet to be completely established. If nonoperative treatment fails, several restorative and palliative surgical techniques are currently optional. Historically, joint debridement has shown good results, and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems to be a promising procedural advance, particularly when large humeral osteophytes are present.