2025 AANA/ASES Specialty Day All-Access Pass-AANA/ASES Session III: Arthritis Bad, Surgery Good

Video Transcription

Video Summary

The session focused on management strategies for glenohumeral arthritis, particularly in younger patients, through a debate and panel discussion among experts. The central patient case is a 60-year-old female with severe arthritis and an intact rotator cuff. Dr. Hartzler advocated for pyrocarbon hemiarthroplasty for younger, active patients (40s-50s), citing early promising survivorship data from Australasia and Europe and its bone-preserving nature. Dr. Seidel argued for reverse total shoulder arthroplasty (RTSA) in older patients (≥60), emphasizing its lower complication and revision rates compared to hemiarthroplasty and arthroscopic management, despite concerns of acromial fractures and longevity; RTSA offers better outcomes and is increasingly safe in younger populations with intact cuffs. Dr. Savoie endorsed arthroscopic debridement and microfracture (CAM procedure) for younger active patients with concentric arthritis, highlighting its role in symptom relief and delaying arthroplasty. The panelists discussed individualized decisions weighing patient age, activity level, glenoid morphology, and surgical risks. Pyrocarbon implants present sizing challenges due to risk of overstuffing but offer a potential 10-15 year functional window before further surgery. Arthroscopy remains a valuable bone-preserving option in early arthritis. Reverse arthroplasty is favored in cases with posterior glenoid deformity or higher-risk anatomy. Advanced imaging and preoperative planning guide appropriate treatment choice. Overall, treatment is tailored, combining arthroscopy, hemiarthroplasty, anatomic or reverse arthroplasty depending on patient factors and disease stage.

Asset Caption

Moderators: April Armstrong, M.D., Gabriella Ode, M.D.
Faculty: Robert U. Hartzler, M.D., M.S., Adam J. Seidl, M.D., Felix H. Savoie III, M.D., Sara L. Edwards, M.D., Brian C. Werner, M.D.

Keywords

glenohumeral arthritis

pyrocarbon hemiarthroplasty

reverse total shoulder arthroplasty

arthroscopic debridement

microfracture CAM procedure

younger active patients

rotator cuff intact

treatment individualization

preoperative planning