Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure

Authors:

Justin J Mitchell, Brent T Warner, Marilee P Horan, M Brett Raynor, Travis J Menge, Joshua A Greenspoon, Peter J Millett

Abstract:

Glenohumeral osteoarthritis (GHOA) is a common cause of shoulder dysfunction and disability, typically characterized by symptoms of pain, weakness, and decreased range of motion. Initial management consists of nonsurgical modalities such as lifestyle and occupational modifications, physical therapy, nonnarcotic pain relievers, and intra-articular injections of steroid or viscosupplement. When these treatments are unsuccessful, surgical options are considered. In elderly or low-demand patients, treatment with total shoulder arthroplasty (TSA) reliably produces excellent clinical outcomes with low revision rates and high patient satisfaction. However, treatment of GHOA in young or highly active patients represents a substantial challenge.

Many surgical approaches for GHOA have been described, including open and arthroscopic debridement, hemiarthroplasty, unipolar or bipolar resurfacing, non-prosthetic or biologic interposition arthroplasty, and TSA. While it has been shown that TSA provides the most reliable outcomes for patients with advanced GHOA, alternative treatments are often sought in younger and more active patients. This may be due to a number of factors, ranging from personal preference to concerns about implant longevity or unwillingness to decrease activity levels postoperatively. Furthermore, several studies have shown unacceptable outcomes of TSA in younger patients, including increased rates of component loosening, decreased component survival, and significantly higher risk of revision. A recent Markov decision analysis found that arthroscopic management of GHOA was the preferred treatment strategy for patients younger than 47 years, while TSA was preferred for patients older than 66 years.

In light of these findings, the senior surgeon (P.J.M.) has developed a joint-preserving arthroscopic strategy termed comprehensive arthroscopic management (CAM) for the treatment of young, active patients with symptomatic GHOA. This procedure addresses many of the potential sources of pain and dysfunction in the osteoarthritic shoulder through a combination of glenohumeral chondroplasty; extensive capsular release; and, when indicated, humeral osteoplasty, osteophyte excision, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture, and biceps tenodesis. In a previously published article on the first 29 patients (30 shoulders) to receive the CAM procedure, patients were found to have a significant reduction in pain and improved range of motion with increased functional outcome scores. Furthermore, the procedure demonstrated 85% survivorship at 2 years. Glenohumeral joint space of less than 2 mm was found to be predictive of progression to TSA. Midterm results in a similar group of patients also demonstrated encouraging findings with 77% survivorship at a minimum 5-year follow-up, with successful patients noting significant improvements in pain, range of motion, and function.

The promising short- and midterm results suggest that the CAM procedure is effective in managing GHOA and delaying the need for TSA in young, active individuals who wish to extend the life span of their native shoulder joint. However, the data are limited by the small sample size and inability to provide surgeons with definitive preoperative patient selection criteria. Despite this, the data do imply that some patients may be more appropriate candidates for this procedure than others, and despite encouraging preliminary results, identifying the factors that are predictive of early failure is paramount for proper patient selection for those who will do well with joint preservation versus replacement. Differentiating those patients who are less ideal candidates for arthroscopic intervention may also lead to improved long-term results by avoiding multiple surgical interventions. Therefore, the purpose of this study is to examine prognostic factors predictive of early failure in patients undergoing the CAM procedure for GHOA. We hypothesized that radiographic joint space narrowing and lower preoperative patient-reported scores would be predictive of early failure of the CAM procedure. Results from this analysis will assist surgeons in selecting proper candidates for this joint-preserving intervention to optimize durability and long-term outcomes.

For the complete study: Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure

Authors:

Abstract:

About the Author: Peter Millett, MD