Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis

Authors:

Justin J Mitchell, Marilee P Horan, Joshua A Greenspoon, Travis J Menge, Dimitri S Tahal, Peter J Millett

Abstract:

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.

Outcomes after a minimum of 2 years in 30 shoulders showed promising results. 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.

For the complete study: Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral 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!!!

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Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis

Authors:

Abstract:

About the Author: Peter Millett, MD