AANA24 Shoulder All-Access Pass-CONCURRENT SCIENTIFIC SESSION 3F: The Athletic Arthritic Shoulder

Video Transcription

Video Summary

The panel discussion focused on managing athletic arthritic and complex shoulder conditions, emphasizing challenges and advances in treatments beyond traditional arthroplasty. Dr. Brian Cole highlighted non-arthroplasty options for glenohumeral joint disease, including debridement, marrow stimulation, osteochondral allografts, and orthobiologics like platelet-rich plasma. He noted that while some treatments delay arthroplasty, long-term success varies, particularly depending on joint involvement and lesion size.<br /><br />Dr. Jeremy Meany discussed options for younger patients (around 40 years old) with severe shoulder arthritis. He reviewed arthroscopic comprehensive arthroscopic management (CAM), hemiarthroplasty with alternative bearings like pyrocarbon, total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). He warned younger patients face higher complication and revision rates, and stressed careful patient selection and counseling about outcomes and risks.<br /><br />Dr. Julia Lee addressed reverse shoulder arthroplasty in relatively young patients with rotator cuff arthropathy, emphasizing patient-dependent decision-making and need for counseling about activity limitations and revision risk. Outcomes in younger patients can approach those of older populations, but complications are serious and revisions likely.<br /><br />A heated debate ensued on the value of 3D preoperative planning and patient-specific instrumentation (PSI) for shoulder arthroplasty. Dr. Lee argued 3D planning often yields inconsistent software measurements, no clinical outcome improvements, and higher costs, suggesting it suits complex revisions only. Dr. Tony Minacci countered, showing 3D planning improves pin placement accuracy over 2D imaging, reducing malposition risks, though PSI guides have less impact.<br /><br />Dr. Alicia Harrison provided a detailed overview of preoperative planning for complex revision arthroplasties, emphasizing complete implant removal, CT imaging for bone loss assessment, involvement of infectious disease specialists, and importance of patient counseling given the complexity.<br /><br />Panelists shared real-world complicated cases involving young patients with rotator cuff deficiency and arthritis, debating between soft tissue procedures (e.g., latissimus or pectoralis transfers), hemiarthroplasty with pyrocarbon implants, or reverse shoulder arthroplasty. Consensus highlighted balancing durability, patient's activity demands, and revision risks when planning treatment.<br /><br />Overall, the session underscored individualized management strategies in complex and young shoulder arthritis patients, nuanced surgical options including biologics and implants, cautious adoption of emerging technologies like 3D planning, and the importance of experienced, multidisciplinary care to optimize outcomes and postpone arthroplasty when possible.

Asset Caption

Introduction by Moderators: Joseph A. Abboud, M.D., Melissa A. Wright, M.D.

Keywords

athletic arthritic shoulder

complex shoulder conditions

non-arthroplasty treatments

glenohumeral joint disease

arthroscopic comprehensive management (CAM)

hemiarthroplasty with pyrocarbon

total shoulder arthroplasty (TSA)

reverse shoulder arthroplasty (RSA)

3D preoperative planning

patient-specific instrumentation (PSI)

rotator cuff arthropathy

revision arthroplasty planning

multidisciplinary shoulder care