Management of Glenohumeral Joint Osteoarthritis

Michael Khazzam, MD, FAAOS; Albert O. Gee, MD, FAAOS; Michael Pearl, MD, FAAOS

Disclosures

J Am Acad Orthop Surg. 2020;28(19):790-794. 

In This Article

Strength of Recommendations Descriptions

Hyaluronic Acid

Strong evidence supports that there is no benefit to the use of hyaluronic acid in the treatment of glenohumeral joint osteoarthritis.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Prognostic Factors (BMI)

Strong evidence suggests that obese patients with glenohumeral osteoarthritis do not experience an increase in the rate of early postoperative complications.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Prognostic Factors (Gender/Sex)

Strong evidence supports that gender/sex is not associated with better or worse postoperative outcomes.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Prognostic Factors (Comorbidities)

Strong evidence suggests that patients with glenohumeral joint osteoarthritis who have more comorbidities experience higher rates of early postarthroplasty complications.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Total Shoulder Arthroplasty

Strong evidence supports that anatomic total should arthroplasty demonstrates more favorable function and pain relief in the short- to mid-term follow-up when compared with hemiarthroplasty for the treatment of glenohumeral osteoarthritis.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Glenoid Implant—Pegged or Keeled

Strong evidence supports that the clinician may use pegged or keeled glenoid implants in patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff. Pegged implants demonstrate less radiolucent lines, but the effect on clinical outcomes and survivorship are unclear.

Strength of Recommendation: Strong****. Implication: Practitioners should follow a Strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Prognostic Factors (Age)

Moderate evidence supports that older age at the time of surgery is associated with lower revision rates.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Prognostic Factors (Smoking)

Moderate evidence suggests that smoking is associated with inferior postoperative outcomes.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Prognostic Factors (Preoperative Function)

Moderate quality evidence suggests that although both higher and lower preoperative functioning patients with glenohumeral joint osteoarthritis will likely experience improvement after arthroplasty, patients with higher preoperative function may experience less functional improvement.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Prognostic Factors (Depression)

Moderate evidence suggests that depression is associated with inferior postoperative outcomes in patients with glenohumeral joint osteoarthritis undergoing arthroplasty.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Glenoid Implant—Metal-backed Noncemented

Moderate evidence supports that surgeons not use metal-backed noncemented glenoid implants.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Total Shoulder Arthroplasty—Subscapularis Peel, Lesser Tuberosity Osteotomy, or Tenotomy

Moderate quality evidence supports that surgeons can use subscapularis peel, lesser tuberosity osteotomy, or tenotomy when performing shoulder arthroplasty.

Strength of Recommendation: Moderate***. Implication: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

Hemiarthroplasty—Stems

Limited evidence supports that clinicians may use stemmed, stemless, or resurfacing prosthesis for patients with glenohumeral joint osteoarthritis undergoing total arthroplasty or hemiarthroplasty.

Strength of Recommendation: Limited**. Implication: Practitioners should feel little constraint in following a recommendation labeled as Limited, exercise clinical judgment, and be alert for emerging evidence that clarifies or helps to determine the balance between benefits and potential harm. Patient preference should have a substantial influencing role.

Preoperative Physical Therapy

In the absence of reliable evidence, it is the opinion of the work group that physical therapy may benefit select patients with glenohumeral joint osteoarthritis.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Postoperative Physical Therapy

In the absence of reliable evidence, it is the opinion of the work group that clinicians may prescribe physical therapy in patients after shoulder arthroplasty.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Injectable Biologics

In the absence of reliable evidence, it is the opinion of the work group that injectable biologics, such as stem cells or platelet-rich plasma, cannot be recommended in the treatment of glenohumeral osteoarthritis.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Alternate Nonsurgical Treatments

In the absence of reliable evidence, the work group cannot recommend for or against the use of the following:

  1. Acupuncture,

  2. Dry needling,

  3. Cannabis,

  4. Cannabidiol (CBD) oil,

  5. Capsaicin,

  6. Shark cartilage,

  7. Glucosamine and chondroitin,

  8. Cupping, and

  9. Transcutaneous Electrical Nerve Stimulation (TENS)

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information as emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Opioid Pain Medication

In the absence of reliable evidence, it is the opinion of the work group that opioids not be prescribed because routine and long-term pain management of glenohumeral osteoarthritis.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Nonprosthetic Surgical Options

In the absence of reliable evidence, it is the opinion of the work group nonprosthetic surgical options may or may not provide short-term benefit for patients with glenohumeral joint osteoarthritis.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Radiographs

In the absence of reliable evidence, it is the opinion of the work group that patients with glenohumeral osteoarthritis undergoing arthroplasty should be imaged with axillary and true AP (Grashey view) radiographs, with imaging performed at the discretion of the clinician.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Cemented Stems

In the absence of reliable evidence, it is the opinion of the work group that either cemented or noncemented stems can be used in the treatment of patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff.

Strength of Recommendation: Consensus. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Anatomic or Revers Total Shoulder Arthroplasty

In the absence of reliable evidence, it is the opinion of the work group that clinicians may use either anatomic TSA or reverse TSA for the treatment of glenohumeral joint osteoarthritis in select patients with excessive glenoid bone loss and/or rotator cuff dysfunction.

Strength of Recommendation: Consensus. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Glenoid Implants—Polyethylene-Metal or All-polyethylene

In the absence of reliable evidence, it is the opinion of the work group that clinicians may use polyethylene-metal hybrid glenoid implants or all-polyethylene implants during TSA for the treatment of glenohumeral joint osteoarthritis.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Bicep Tenodesis and Tenotomy

In the absence of reliable evidence, it is the opinion of the work group that clinicians may consider concomitant biceps tenodesis or tenotomy during shoulder arthroplasty.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Tranexamic Acid

In the absence of reliable evidence, it is the opinion of the work group that utilization of tranexamic acid during shoulder arthroplasty may result in reduced blood loss and reduced risk of blood transfusion.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Supraspinatus Tears

In the absence of reliable evidence, it is the opinion of the work group that for patients with small isolated, repairable supraspinatus tears, clinicians can perform anatomic TSA.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Discharge

In the absence of reliable evidence, it is the opinion of the work group that same-day discharge is an option after shoulder arthroplasty in selected patients.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Cryotherapy

In the absence of reliable evidence, it is the opinion of the work group that either continuous cryotherapy or cold packs can be used after shoulder arthroplasty.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

Multimodal Pain Management

In the absence of reliable evidence, it is the opinion of the work group that multimodal pain management strategies or nonopioid individual modalities can provide added benefit for postoperative pain management after shoulder arthroplasty.

Strength of Recommendation: Consensus*. Implication: In the absence of reliable evidence, practitioners should remain alert to new information because emerging studies may change this recommendation. Practitioners should weigh this recommendation with their clinical expertise and be sensitive to patient preferences.

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