Considerations in treating shoulder arthritis in patients under 50 years of age

Este artículo es originalmente publicado en:

Monday, December 15, 2014

Considerations in treating shoulder arthritis in patients under 50 years of age

Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts

Glenohumeral arthritis in young individuals seems to be increasingly diagnosed and offered surgical treatment. As we’ve posted before these young individuals have different types of arthritis than their older counterparts – many are associated with failed prior surgeries, including chondrolysis, anchor problems in labral repairs, infection, and capsulorrhaphy arthropathy. Other causes of arthritis in young folks include avascular necrosis, inflammatory arthropathy, and glenoid dysplasia. Finally, young individuals may present with earlier stages of arthritis because of their inability to perform at their desired level. Thus there are at least three reasons why the management of arthritis in younger individuals is more demanding: (1) higher patient expectations, (2) increased longevity, (3) more complex pathology and (4) earlier presentation.

This is a review of many of the surgical options for the management of shoulder arthritis in the young person. It is apparent that thoughtful discussion of these options is warranted with each young patient considering shoulder arthroplasty. Longer term followup of these patients stratified by diagnosis will be of great interest.
The authors make a point about the ream and run procedure, «Whereas the described technique does not ream completely through subchondral bone, there is some concern that excessive reaming into the subchondral bone will lead to progressive glenoid erosion and medialization of the glenohumeral joint. It is unclear how this will affect long-term outcome, but it might make subsequent placement
of a glenoid prosthesis difficult if not impossible.»  
In this regard it is important to emphasize (as shown in the figure below), our technique for the ream and run procedure removes only enough bone to achieve a single glenoid concavity, it removes less bone than what is necessary to insert a standard polyethylene glenoid component,  a stepped polyethylene glenoid component, or a metal-backed glenoid component.