Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint.

Patrick Henry,Jesse A Slade Shantz,Tim Dwyer,Richard Holtby,Helen Razmjou

doi:10.1186/s12891-015-0741-9

Abstract

BackgroundArthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. The purpose of this study was twofold: 1) to examine the impact of arthroscopic debridement with or without subacromial decompression on clinical outcomes in patients with severe glenohumeral osteoarthritis (OA), and 2) to explore the differences in post-debridement outcomes between patients who eventually progressed to arthroplasty vs. those who did not. The role of an active worker’s compensation claim was examined.MethodsProspectively collected data of patients who were not good candidates for shoulder arthroplasty and had subsequently undergone arthroscopic shoulder debridement were used for analysis. Disability was measured using the relative Constant-Murley score (CMS), the American Shoulder and Elbow Surgeon’s (ASES) assessment form, pain free range of motion (ROM), and strength.ResultsFifty-six patients were included in the final analysis. Eighteen (32 %) patients underwent arthroplasty surgery (arthroplasty group) over a period of 11 years. The arthroplasty group was comparable with the non-arthroplasty group prior to debridement but was more disabled at post-debridement surgery follow-up, functioning at less than 50 % of normal based on ASES, relative CMS, and active painfree ROM. In the multivariable analysis, the post-debridement relative CMS was affected by having a compensation claim and having a future arthroplasty.ConclusionArthroscopic debridement improved clinical outcome in 68 % of patients suffering from advanced OA of glenohumeral joint. Having less than 50 % of normal score in ASES, relative CMS and painfree ROM post- debridement within a period of two years may be an indication for future arthroplasty. Role of worker’s compensation claims should not be underestimated.

Highlights

Arthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision
For patients over the age of 60 who can comply with instructions to place relatively low functional demands on their shoulder, shoulder arthroplasty is the mainstay of treatment and provides reliable symptom relief [2]
The results of this study demonstrate that debridement for glenohumeral OA is an effective procedure to improve symptoms, pain free range of motion (ROM) and strength for the majority of patients (68 % of in our sample)

Summary

Introduction

Arthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. Several variations of the procedure have been described, including arthroscopic debridement of loose chondral tissue, removal of loose bodies, capsulotomy, and microfracture, along with other concomitant arthroscopic procedures such as subacromial decompression, long-head of the biceps management, and distal clavicle resection [6, 10,11,12,13,14,15,16] In most reports, these operative techniques have led to improved patient satisfaction and functional outcome scores. For many patients in these studies the arthritic process was so mild that it was not detected on pre-operative x-rays [6, 10, 13,14,15]

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