AANA Lab Course 912 - Arthroscopic Shoulder Solutions-Arthroscopic Treatment of Shoulder Osteoarthritis-Larry D. Field, M.D.

Arthroscopic Treatment of Shoulder Osteoarthritis-Larry D. Field, M.D.

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This presentation by Dr. Larry D. Field addresses arthroscopic treatment options for shoulder arthritis, particularly focusing on younger, active patients. Shoulder arthritis, primarily degenerative joint disease (DJD), leads to pain and disability. While total shoulder arthroplasty (TSA) is highly successful in elderly patients, its use in younger, high-demand individuals is controversial due to concerns about implant longevity and revision rates.<br /><br />Initial management typically includes physical therapy, activity modification, NSAIDs, and corticosteroid injections. Surgical options range from arthroscopic debridement—which preserves the joint and treats secondary issues like loose bodies and rotator cuff pathology—to various forms of shoulder arthroplasty including hemiarthroplasty, biologic resurfacing, ream-and-run procedures, and TSA.<br /><br />Arthroscopic debridement (CAM procedure) shows moderate success, with 77-84% survivorship at mid-term follow-up, and is often considered a joint-preserving alternative that can delay or avoid arthroplasty. Arthroscopic interventions may be less invasive and have fewer complications than hemiarthroplasty or TSA.<br /><br />Hemiarthroplasty is less painful than no surgery but generally less effective than TSA; biologic resurfacing attempts to improve outcomes by using grafts (fascia, meniscal allograft), but failure rates vary. The ream-and-run technique avoids glenoid component issues but requires precise patient selection and surgical skill.<br /><br />TSA remains the gold standard for reliable pain relief and functional improvement but poses higher revision and complication risks in patients under 60, with glenoid loosening and humeral head subluxation common over time.<br /><br />Diagnostic evaluation includes history, physical exam focusing on stability and motion, imaging (X-rays, CT for glenoid anatomy), and surgery reports. Understanding specific etiologies such as post-traumatic arthritis or capsulorrhaphy arthropathy is key to management.<br /><br />In summary, arthroscopic debridement can be successful for selected patients, while shoulder arthroplasty is reserved for advanced disease. Treatment decisions should be individualized considering patient age, pathology, and functional demands.

Keywords

shoulder arthritis

arthroscopic treatment

younger patients

degenerative joint disease

total shoulder arthroplasty

arthroscopic debridement

hemiarthroplasty

biologic resurfacing

ream-and-run procedure

shoulder surgery outcomes