Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis

Authors:

Olivier A. van der Meijden, Trevor R. Gaskill, and Peter J. Millett

Abstract:

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 can be equally debilitating.

Treatment of shoulder OA is typically based on the patient’s age, severity of symptoms, level of activity, radiographic findings, and medical co morbidities. Nonoperative treatment options include activity modification, physical therapy, oral anti-inflammatories, and intra-articular injections, each exhibiting varying reported efficacy rates. If conservative options fail, surgical treatment should be considered. As in other joints affected by severe OA, the most definitive treatment modality is joint arthroplasty. Specifically, shoulder arthroplasty reliably results in pain reduction and functional improvement but has been primarily studied in older arthritic patients with lower functional demands.

The management of shoulder OA in young active patients remains a challenge and the optimal treatment has yet to be completely established. Many young and active patients with early stage joint degeneration wish to maintain a high level of activity because of recreational interests or occupational demands. In these cases, arthroplasty may not be a practical treatment option secondary to concerns regarding implant durability. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement.

Glenohumeral joint preservation is not a novel concept. Previous authors have described arthroscopic debridement and capsular release, microfracture, corrective osteotomies, osteochondral transfers, and chondral implantations with satisfactory results. More recently arthroscopic debridement and capsular release has been coupled with humeral osteoplasty and axillary nerve decompression in an effort to improve reported outcomes. These procedures also typically have the benefit of less surgical morbidity and a quicker postoperative recovery.

The long-term outcomes of glenohumeral preservation techniques are presently unknown but clinical experience has shown that many patients do well with these procedures and delay the need for prosthetic shoulder arthroplasty. Early results from published studies do indicate that satisfactory short-term outcomes can be expected, but these procedures have yet to show that they can halt the arthritic progression. They may, however, provide a window of improved function for this young and active population. The purpose of this paper is to give an overview of the currently available joint preserving surgical techniques and report on the evidence supporting procedures available for the young and active patient population with shoulder OA.

For the complete study: Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis

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!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis

Authors:

Abstract:

About the Author: Peter Millett, MD