ICL 207 Glenhumeral Arthritis in the Young Patient: Arthroscopic and Other Options-Clavert Handout

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This presentation reviews shoulder arthroplasty options for young patients (under 50 years) with glenohumeral arthritis, focusing on outcomes, complications, and revision rates of hemiarthroplasty (HA) and total shoulder arthroplasty (TSA). While prosthetic shoulder arthroplasty effectively relieves pain and restores function, concerns about implant longevity have limited its use in younger, more active patients with longer life expectancy.<br /><br />Literature shows short- to mid-term outcomes for HA and TSA are generally favorable, with improved pain and range of motion, especially in elevation and external rotation. HA often yields less satisfactory results due to untreated or progressive glenoid arthrosis and stiffness. Long-term data indicate comparable results between HA and TSA in the initial 5 years, but TSA shows superior clinical outcomes over time. However, TSA faces challenges with glenoid component loosening over the long term. For example, the Mayo Clinic's 20-year follow-up reported survival rates of 75.6% for HA and 83.2% for TSA, with revision rates of 19% and 11%, respectively. Registry data support these findings, favoring TSA for young patients but emphasizing a high revision risk overall.<br /><br />Alternative or adjunct procedures, such as the “ream-and-run” glenoid technique and biological resurfacing, have been attempted to delay glenoid component implantation. However, these methods lack robust long-term evidence and have not demonstrated consistent efficacy. Soft-tissue interposition, initially promising, showed clinical decline and progressive glenoid erosion over time and is no longer recommended.<br /><br />In conclusion, while HA and TSA can provide long-term pain relief and functional improvement in young arthritic patients, surgeons must weigh the substantial revision risk. Alternative procedures need further study before routine adoption. Careful patient selection and counseling are critical in managing glenohumeral arthritis in young individuals.

Keywords

shoulder arthroplasty

young patients

glenohumeral arthritis

hemiarthroplasty

total shoulder arthroplasty

implant longevity

revision rates

glenoid component loosening

ream-and-run technique

biological resurfacing