Glenohumeral Osteoarthritis in the Young Patient : Evaluation and Management

The management of glenohumeral arthritis in the young patient remains a challenging problem for the treating clinician. The activity demands seen in such patient populations require a unique understanding of what the goals of treatment are to ensure satisfied and sustainable outcomes. In addition, younger patients have a longer life expectancy and more active lifestyles, which can negatively impact the longevity of arthroplasty implants that are traditionally used in the older patient population. As such, the discovery and implementation of novel and anatomy preserving techniques continue to evolve to meet the demand of younger patients without compromising their outcomes. This practical text serves to educate the treating clinician on how to recognize and categorize glenohumeral osteoarthritis in young patients and offers insight into the various operative and non-operative treatment options. Opening chapters examine the prevalence and burden, etiology and evaluation of the condition, followed by chapters discussing the current non-invasive and non-operative approaches to treatment, such as injection therapy. The main complement of chapters are detailed descriptions of surgical approaches, from arthroscopy and cartilage reconstruction to total and reverse shoulder arthroplasty, stemless approaches and arthrodesis. A final chapter expands on future management strategies. Radiographs and intraoperative photos are provided to enhance the text. Presenting the state of the art for this increasingly common condition, Glenohumeral Osteoarthritis in the Young Patient is an ideal resource for orthopedic surgeons and sports medicine specialists alike. Preface 5 Contents 6 Contributors 8 1: Burden of Glenohumeral Osteoarthritis in the Young Patient 10 Introduction 10 Epidemiology 10 Definition 11 Clinical Diagnosis 11 Radiographic Diagnosis 12 Ultrasound (US) 13 Computed Tomography (CT) 13 Magnetic Resonance Imaging (MRI) 15 Nuclear Medicine (NM) 16 Arthroscopic Diagnosis 16 Trends in Diagnosis 16 Financial Burden 17 The Health Care System 17 The Patient 17 Age-Related Concerns 18 Functional Demands 18 Joint Salvage Outcomes 18 Arthroplasty Longevity Outcomes 19 References 21 2: Etiology of Glenohumeral Osteoarthritis in the Young Patient 23 Introduction 23 Instability Arthropathy 24 Fracture Related 25 Atraumatic Osteonecrosis 26 Iatrogenic 28 Intra-articular Hardware 28 Postarthroscopic Glenohumeral Chondrolysis (PAGCL) 28 Intra-articular Pain Pumps 29 Thermal Capsulorrhaphy 29 Suture Capsulorrhaphy 30 Septic Arthritis 30 Inflammatory Arthritis 31 Glenoid Dysplasia 31 Neuropathic 32 References 34 3: Evaluation of Glenohumeral Osteoarthritis in the Young Patient 38 Introduction 38 History and Physical Exam 39 Diagnostic Imaging 40 Plain Radiographs 40 Advanced Imaging 42 Computed Tomography (CT) 42 Magnetic Resonance Imaging (MRI) 45 Summary 47 References 47 4: Noninvasive Treatment Options for Glenohumeral Osteoarthritis in the Young Patient 50 Introduction 50 Nutrition – Diet 51 Nutrition – Supplements 52 Medications 54 Physical Therapy 55 Home Exercise Programming and Physician-Directed Rehabilitation 56 Acupuncture 57 Electrical Stimulation 58 Ultrasound 58 Iontophoresis 59 Kinesiology Tape 59 Blood Flow Restriction 60 Temperature Therapy 60 Conclusion 61 References 61 5: Injection Therapies for Glenohumeral Osteoarthritis in the Young Patient 66 Introduction 66 Approach to Injections 67 Corticosteroid Injections 67 Hyaluronic Acid 69 Platelet-Rich Plasma 71 Stem Cells 72 Conclusion 73 References 73 6: Arthroscopic Treatment of Glenohumeral Arthritis in the Young Patient 76 Introduction 76 When Is Surgical Arthroscopy the Right Answer? 77 Arthroscopic Management 78 Comprehensive Arthroscopic Management 78 Microfracture 80 Arthroscopic Biologic Resurfacing and Interposition 82 Limitations of Surgical Arthroscopy When Managing Glenohumeral Arthritis 83 Conclusion 84 References 84 7: Bone Preserving Resurfacing Treatment Options for Glenohumeral Osteoarthritis in the Young Patient 88 Introduction 88 Biomechanics 90 Author’s Preferred Technique 91 Rehabilitation 92 Complications 92 Outcomes 93 Summary 95 References 95 8: Stemless Shoulder Arthroplasty for Glenohumeral Arthritis in a Young Patient 97 Background 97 Stemless Shoulder Arthroplasty Versus Humeral Head Resurfacing 98 Biomechanics 99 Indications and Contraindications 100 Current Designs 101 Bony Response to Implantation 102 Preoperative Planning 103 Techniques 103 Rehabilitation 106 Outcomes 106 Summary 107 References 108 9: Ream and Run for Glenohumeral Arthritis in a Young Patient 113 Introduction 113 Historical Perspective 113 Patient Selection 115 Surgical Technique [13, 28] 115 Post-op Rehabilitation and Care 119 Outcomes 120 References 121 10: Total Shoulder Arthroplasty for Glenohumeral Arthritis in a Young Patient 124 Who Is the Young Patient Considering Prosthetic Shoulder Arthroplasty? 124 Challenges: Demands, Expectations, and the Desire to Avoid Multiple Revisions 125 Proliferation of Prosthetic Shoulder Arthroplasty in Young Patients 125 Diagnosis Influences Treatment Options 126 Rationale for Anatomic Total Shoulder Arthroplasty 128 Implant Choices in Anatomic Total Shoulder Arthroplasty: Humeral Implants 129 Glenoid Implants 132 Anatomic Total Shoulder Arthroplasty Versus Hemiarthroplasty in Young Patients 135 Anatomic Total Shoulder Arthroplasty Versus Ream and Run 137 Considerations in Specific Patient Populations 138 Capsulorrhaphy Arthropathy 138 Dislocation Arthropathy 139 Chondrolysis 139 Total Shoulder Arthroplasty in Very Young Patients 140 Conclusions 140 References 141 11: Reverse Shoulder Arthroplasty for Glenohumeral Arthritis in a Young Patient 147 Preface 147 Preoperative Assessment 149 Rotator Cuff Tear Arthropathy 151 Osteoarthritis and Glenoid Asymmetry 152 Revision Arthroplasty 153 Complications 154 Outcomes 156 References 162 12: Arthrodesis for Glenohumeral Osteoarthritis in a Young Patient 168 Background 168 Indications 168 Contraindications 169 Preoperative Planning 170 Technique 170 Position 170 Fixation Methods 171 Outcomes 175 Complications 175 Clinical Results 176 Arthrodesis to Arthroplasty Conversion 179 Conclusion 179 References 180 13: Putting It All Together: What’s on the Horizon for a Young Patient with Glenohumeral Osteoarthritis? 183 Introduction 183 Non-operative Treatment Modalities 183 Noninvasive Therapy 184 Injection Therapies 184 Orthobiologic Therapies 184 Surgical Management 186 Arthroscopic Management 186 Total Shoulder Arthroplasty 188 Conclusion 191 References 191 Index 195