Editorial: Minimally invasive surgery options in managing shoulder osteoarthritis

Abstract

Over the past 30 years, highly refined techniques leading to innovative approaches and major advances in Orthopaedic Surgery have occurred, resulting in different so-called minimally invasive procedures. The evolution of surgical capabilities with the introduction of minimally invasive techniques recently begins to take shape claiming undiscussed advantages such as limited exposure, limited damage to surrounding tissue, reduction of post-operative pain, reduction in the length of stay in the hospital, in time to return to work, and in overall cost [1]. Although minimally invasive surgery have become widespread for hip or knee arthroplasty procedures, this approach is still not commonly undertaken for shoulder joint replacement [2]. Shoulder resurfacing technique has recently gained popularity as a minimal invasive alternative to conventional shoulder arthroplasty for the treatment of glenohumeral arthritis [3, 4]. Understandably, patients affected by shoulder osteoarthritis who read or hear about the advantages of smaller incisions and a speedier recovery are eager to opt for the aforementioned technique. On the other side orthopaedic surgeons have in their hands different minimally invasive surgical options to adopt in order to effectively manage shoulder gleno-humeral joint arthritis. Over the years standard shoulder arthroplasty was demonstrated to be a reliable procedure, after conservative attempts failure, both to relieve pain and restore function in well-selected patients [4]. Recently resurfacing technique offers a new minimally invasive surgical option with respect of conventional arthroplasty. While conventional shoulder arthroplasty involves removal of the entire humeral head followed by placement of an intramedullary stem into the proximal aspect of the humerus, resurfacing technique consists of reaming the proximal portion of the humeral head and fitting a metal-alloy cap over the remainder of the head [4, 5]. As the standard procedure the humeral component may or may not be associated to a glenoid component [4]. Another recent minimally invasive attempt is represented by partial resurfacing prosthesis, consisting of a tapered post and cobalt-cromium surface component that screw together [6, 7]. The latter combined with biologic resurfacing, also known as interpositional arthroplasty, seems to obtain great consent especially when treating young active patients, but further investigations are required [8]. Some authors proposed arthroscopic glenoid resurfacing as a surgical treatment for glenohumeral arthritis in the young patients reporting optimal mid term results [9]. Ultimately there is very little in the literature of arthroscopic joint debridement for osteoarthritis unless it is confined to early stages in which the humeral head remains spherical and concentrically reduced within the normal glenoid. On the contrary, the lonely debridement performed for degenerative process involving both sides of the joint was demonstrated to lead to unsatisfactory results [10]. Considering the potential advantages of surface replacement and its reliability, confirmed analyzing both G. Porcellini (&) President SICSeG Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Via L.V. Beethoven 1, 47841 Cattolica (RN), Italy e-mail: chirurgiaspalla@virgilio.it