Osteoarthritis (OA) is the most frequent cause of disability in the USA [1
]. It is suggested that as many as 50 million adults suffer from this gradual, progressive joint failure [2
]. The prevalence of OA increases with age, typically manifesting after the sixth decade of life, and women appear to be more susceptible than men [2
]. Though less prevalent than OA of the knee and hip, OA of the shoulder () can be equally debilitating [3
Arthroscopic view of severe osteoarthritis of the right humeral head in a 53-year-old female.
Treatment of shoulder OA is typically based on the patient's age, severity of symptoms, level of activity, radiographic findings, and medical co morbidities. Nonoperative treatment options include activity modification, physical therapy, oral anti-inflammatories, and intra-articular injections, each exhibiting varying reported efficacy rates [4
]. If conservative options fail, surgical treatment should be considered. As in other joints affected by severe OA, the most definitive treatment modality is joint arthroplasty. Specifically, shoulder arthroplasty reliably results in pain reduction and functional improvement but has been primarily studied in older arthritic patients with lower functional demands [5
The management of shoulder OA in young active patients remains a challenge and the optimal treatment has yet to be completely established [12
]. Many young and active patients with early stage joint degeneration wish to maintain a high level of activity because of recreational interests or occupational demands. In these cases, arthroplasty may not be a practical treatment option secondary to concerns regarding implant durability [13
]. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement.
Glenohumeral joint preservation is not a novel concept. Previous authors have described arthroscopic debridement and capsular release [14
], microfracture [17
], corrective osteotomies, osteochondral transfers, and chondral implantations [20
] with satisfactory results. More recently arthroscopic debridement and capsular release has been coupled with humeral osteoplasty and axillary nerve decompression in an effort to improve reported outcomes [22
]. These procedures also typically have the benefit of less surgical morbidity and a quicker postoperative recovery.
The long-term outcomes of glenohumeral preservation techniques are presently unknown but clinical experience has shown that many patients do well with these procedures and delay the need for prosthetic shoulder arthroplasty. Early results from published studies do indicate that satisfactory short-term outcomes can be expected, but these procedures have yet to show that they can halt the arthritic progression [14
]. They may, however, provide a window of improved function for this young and active population. The purpose of this paper is to give an overview of the currently available joint preserving surgical techniques and report on the evidence supporting procedures available for the young and active patient population with shoulder OA.