Abstract
IntroductionGlenohumeral joint degeneration in young patients has varying aetiology and provides a challenging clinical problem whose management is controversial. This review aims to provide an overview of the surgical options for managing these young patients. MethodsA systematic review of the literature was conducted in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. Cases series and comparative studies reporting on surgical interventions for glenohumeral joint degeneration in young patients (<65 years or a mean age <60 years) were included. Robustness of study methodology was appraised using the Methodological index for non-randomised studies. Results30 eligible studies were identified; 10 hemiarthroplasty (HA) and glenoid resurfacing, 4 HA and glenoid reaming, 4 total shoulder arthroplasty (TSA), 3 glenoid resurfacing, 3 arthroscopic debridement, 3 reverse shoulder arthroplasty (RSA), 2 humeral resurfacing and 1 pyrocarbon interposition arthroplasty. Arthroscopic treatments reported good post-operative functional results, but revision rates ranged from 15.8% to 22% at short term follow-up. Although HA and glenoid resurfacing provided an improvement in functional scores, a high revision rate was reported in most studies (9.1%–77%) which was higher than after HA and glenoid reaming (2.8%–16.7%) and humeral resurfacing (2%–12%). TSA was reported to improve the mean Constant Score from 34 to 64 but glenoid loosening ranged from 17.6% to 43.8% and revision rate 6.5%–34% across the studies. ConclusionSurgical intervention in young patients with glenohumeral degeneration carries higher risk of failure and subsequent need for potentially complex revision surgery. Therefore, non-operative measures should be exhausted and patients adequately counselled prior to proceeding to arthroplasty.
Published Version
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