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