Glenohumeral Arthritis

GLENOHUMERAL ARTHRITIS

 Aetiology:

• Osteoarthritis(associated with posterior glenoid wear)
• Rheumatoid arthritis( assoc. with central glenoid wear)
• Secondary degenerative joint disease

-Repetitive and major trauma

-End-stage AVN

-Rotator cuff tear arthropathy

-Arthritis associated with instability or surgery for instability

Clinical Features:

–        Pain and stiffness in the shoulder

–        adduction and internal rotation deformity of the joint maybe produced by protective muscle spasm In active rheumatoid arthritis of the glenohumeral joint

X-rays:

• AP and axillary
• Posterior wear of the glenoid may be seen in osteoarthritis, and symmetric joint space narrowing may be seen in rheumatoid arthritis.
• Superior subluxation of the humeral head may indicate an associated rotator cuff tear.
• A thrower’s exostosis (in athletes) on the posterior inferior glenoid, maybe seen on the Stryker notch view.

Treatment:

• Initial conservative treatment consists of analgesics, ROM exercises, Corticosteroid injection into the joint
• Arthroscopic debridement can be done which consists of loose body removal, chondroplasty and capsular release
• Arthroscopic debridement is most likely to benefit patients with mild glenohumeral arthritis, small lesions, and involvement of only one side of the glenohumeral joint.
• Arthroscopy is preferred in younger patients to prolong the need for a shoulder arthroplasty
• Contraindications to arthroscopic debridement include older patients with global arthritis who are candidates for shoulder arthroplasty, marked posterior glenoid wear (or nonconcentric wear), severe joint contracture and bone loss on the humeral side.
• Arthroscopic Glenoidplasty: reestablishing the normal radius of curvature of the glenoid so that the humeral head is centered in the glenoid, especially in patients with posterior glenoid wear who are susceptible to posterior glenohumeral subluxation.
• Humeral head resurfacing(hemi and total)appears to be promising because the bone stock is preserved. Long term outcome studies are not yet available for this procedure.

– Pre requisites for shoulder resurfacing include adequate proximal humeral bone stock to support the short peg and implant

– Obtaining proper lateral offset is the key, since it helps the rotator cuff to function properly

– Patient selection  is important: motion  should be relatively well preserved and there should be minimal/centralized glenoid wear(without posterior static subluxation or concavity)

• Hemiarthroplasty and Total Shoulder Arthroplasty relieves chronic pain.
• Pain relief, better function and lesser chances of revision are the advantages of total shoulder arthroplasty.
• The problems with total shoulder arthroplasty is the glenoid component, which is the weak link in the procedure.
• Options for glenoid side include: use of all polyethylene component, metal backed poly,Matsen’s ream and run technique or usage of glenoid interposition grafts.
• Contraindications to shoulder arthroplasty include active infection, absence of both deltoid and rotator cuff musculature, neuropathic arthropathy and intractable instability
• Indications for shoulder arthrodesis has declined considerably.
• Indications for arthrodesis in patients with glenohumeral arthritis are limited to failed arthroplasty, chronic infection, severe neurological injury, and a massive rotator cuff tear in conjunction with deltoid deficiency
• The role for osteochondral autograft transplantation is just being evaluated

Ref:

1. Bishop JY, Flatow EL. Management of glenohumeral arthritis: A role for arthroscopy? Orthop Clin North Am 2003; 34:559-566
2. Nakagawa Y, Hyakuna K, Otani S, et al. Epidemiologic study of glenohumeral osteoarthritis with plain radiography. J Shoulder Elbow Surg 1999; 8:580-584.
3. Orthopaedic Knowledge Update-10, 2011, AAOS