Glenohumeral osteoarthritis (GHOA) is a common cause of shoulder pain and dysfunction. The initial treatment typically consists of nonoperative measures including physical therapy, pharmacotherapy, injections, and activity modifications. When nonoperative treatment fails, surgical options include arthroscopic debridement, biological interposition arthroplasty, hemiarthroplasty, or total shoulder arthroplasty (TSA). TSA is typically considered the gold-standard treatment for bipolar disease. While TSA offers predictable and reliable outcomes for many patients, concerns regarding the longevity of the implants, potential for revision surgeries, increased patient expectations, and higher patient demands contribute to less desirable outcomes in younger patients. Because of this, arthroscopic treatment options have been used in an attempt to delay the need for arthroplasty in younger, more active patients or in those patients in whom arthroplasty is otherwise not an acceptable treatment option.
Millett and Gaskill and Millett introduced the comprehensive arthroscopic management (CAM) procedure in an attempt to address the known pain generators of the osteoarthritic shoulder. The CAM procedure built on previously reported arthroscopic treatment options for arthritis, which included debridement, chondroplasty, synovectomy, loose body removal, capsular release, and subacromial decompression, but also added inferior humeral osteoplasty, axillary nerve neurolysis, biceps tenodesis, and microfracture (Figure 1).
Outcomes after a minimum of 2 years in 30 shoulders showed promising results.10,13 Patients who underwent the CAM procedure demonstrated significant improvements in the American Shoulder and Elbow Surgeons (ASES) score and pain levels. Furthermore, survivorship analysis, as defined by progression to TSA, showed a 92% survivorship rate at 1 year and an 85% survivorship rate at 2 years. One of the potential problems with this earlier study was the short follow-up of a minimum of 2 years. At that time point, it was conceivable that some patients might simply be coping with an unsatisfactory result and that, in the longer term, they would convert to TSA.
Given the early promising results of the CAM procedure and the concerns about the potential confounder of a shorter follow-up, the purpose of this study was to report midterm outcomes and survivorship for the CAM procedure for the treatment of GHOA at a minimum 5-year follow-up. We hypothesized that a majority of patients who underwent the CAM procedure would demonstrate sustained improvement in postoperative patient-reported outcomes and maintenance of the native glenohumeral joint without conversion to TSA.