Arthroscopic Joint Debridement Research Articles

Retracted: Efficacy Evaluation of the Combined Platelet-Rich Plasma and Hyaluronic Acid after Arthroscopic Joint Debridement in Treating Knee Osteoarthritis.

[This retracts the article DOI: 10.1155/2022/6994017.].

Orthopedic surgical procedures in people with hemophilia.

People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and arthropathy chiefly affecting their ankles, knees, and elbows. In addition, muscular hematomas, albeit less frequently, may also result in complications such as acute compartment syndrome, pseudotumors, bone cysts and peripheral nerve compression. Joint lesions may require some of the following surgical interventions: arthroscopic synovectomy (in cases of synovitis), arthroscopic joint debridement, radial head resection, opening-wedge tibial osteotomy, arthrodesis, arthrodiastasis (of the ankle), tendon lengthening (hamstrings, Achilles tendon), progressive extension of the knee by placing an external fixator in cases of flexion contracture of the knee, supracondylar femoral extension osteotomy in cases of knee flexion contracture and, eventually, a total joint arthroplasty when the affected joint has been destroyed and the patient experiences severe joint pain. Total knee arthroplasty in hemophilic patients is associated with a high infection risk (7% on average). As regards the complications following muscle hematomas, acute compartment syndrome requires urgent performance of a fasciotomy when hematological treatment is incapable of resolving the problem. Surgical resection of hemophilic pseudotumors is the best solution, with those affecting the pelvis (secondary to iliopsoas hematomas) being particularly difficult to resolve. Peripheral nerve lesions can often be effectively addressed with hematological treatment, although a surgical neurolysis of the ulnar nerve is indicated if nonoperative treatment fails.

Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis.

Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures. We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention. Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise. The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.

Functional outcome of arthroscopic joint debridement in osteoarthritis knee patients, performed in a tertiary care teaching hospital in south Kerala: A prospective study

Functional outcome of arthroscopic joint debridement in osteoarthritis knee patients, performed in a tertiary care teaching hospital in south Kerala: A prospective study

Efficacy Evaluation of the Combined Platelet-Rich Plasma and Hyaluronic Acid after Arthroscopic Joint Debridement in Treating Knee Osteoarthritis.

Objective The study is aimed at observing the efficacy of the combined platelet-rich plasma and hyaluronic acid after arthroscopic joint debridement in treating knee osteoarthritis (KOA). Methods 126 patients with KOA admitted to the Affiliated People's Hospital of Ningbo University and Taizhou Orthopaedic Hospital from 2018-11 to 2021-11 were selected. All nominees were grouped by random drawing; group B (63 cases) received arthroscopic joint debridement while group A (63 cases) received platelet-rich plasma and hyaluronic acid based on group B. The following metrics are counted, including total efficiency, knee joint pain and function, inflammatory cytokines levels, and oxidative stress indicator levels; the complication rate is counted. Results The total effective rate of group A (93.65%) was higher than that of group B (77.78%) (P < 0.05), and there was no significant difference in the incidence of complications between the groups (P > 0.05). Three months after treatment, knee joint pain and function, inflammatory cytokine levels, and oxidative stress indicators levels in group A were better than in group B (P < 0.05). Conclusion The combined platelet-rich plasma and hyaluronic acid after arthroscopic joint debridement in treating KOA can achieve significant effects, reduce knee pain, accelerate the recovery of knee joint function, relieve inflammation, and inhibit oxidative stress and has high safety.

Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital.

BackgroundSeptic arthritis (SA) of the knee following anterior cruciate ligament reconstruction (ACLR) is considered a catastrophic complication in terms of reduced or loss function of the involved joint. The aims of this study were to gauge the incidence, risk factors, and causative organisms of SA after ACLR.MethodsWe conducted a retrospective review of 836 patients who underwent primary ACLR at our institution from October 2018 to September 2021. Patients’ demographics, onset of presentation, clinical symptoms, laboratory findings, and management details were obtained from patients’ electronic medical records.ResultsOut of the 836 primary ACLRs, 12 were complicated with SA (1.43%). Independent risk factors associated with SA included age (OR; 11.12, 95% CI; 1.3–94.97), obesity (OR; 8.51, 95% CI; 1.02–71.13), and diabetes mellitus (OR; 12.58, 95% CI; 2.39–66.3). Staphylococcus aureus was the most frequent culprit organism (66.7%), followed by Streptococcus species (25%), and Pseudomonas aeruginosa (8.3%). No fungal, mycobacterial, or polymicrobial growth were recovered from synovial fluid cultures. All of the infected cases underwent arthroscopic joint lavage and debridement in the operating room followed by intravenous antibiotics. Graft removal was not done in any of the involved patients, with eradication of infection in all cases.ConclusionSA after ACLR is uncommon, with S. aureus identified in about two-thirds of the patients. Prompt diagnosis and treatment are crucial to avoid graft loss and arthritis-associated joint damage. Orthopedic surgeons should consider rigorous implementation of infection control strategies to minimize the incidence of this devastating morbidity.

Can a fibular malunion be corrected by a Z-shaped fibular osteotomy?

The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent realigning Z‑shaped fibular osteotomy. Between January 2007 and December 2014, 28patients with apainful fibular malunion underwent aZ-shaped realignment fibular osteotomy. The mean age was 42.2 ± 14.1 years (range 19.1-67.8 years) and the mean follow-up was 7.0 ± 1.7 years (range 4.0-9.7 years), with no loss to follow-up. Weight-bearing radiographs were used to determine the distal fibula alignment based on Weber's criteria. Degenerative changes of the tibiotalar joint were assessed using the Kellgren-Lawrence scale. Clinical assessment included pain evaluation, measurement of ankle range of motion (ROM), sports activities, and quality of life outcomes. There were no intraoperative or perioperative complications. No delayed unions or nonunions were observed. One patient had radiographic progression of degenerative changes in the tibiotalar joint. Postoperative complications included removal of hardware (n = 15) and arthroscopic tibiotalar joint debridement (n = 2). At the last follow-up the mean visual analog scale (VAS) decreased from 6.5 ± 1.1 to 2.1 ± 1.1 (p < 0.001),the ROM improved from 39º ± 6º to 45º ± 4.5º (p < 0.001), the short form health survey questionnaire (SF-36) physical and mental outcome scores improved from 49 ± 8 to 84 ± 7 (p < 0.001) and from 61 ± 4 to 83 ± 5 (p < 0.001), respectively. The Z‑shaped realignment osteotomy of the distal fibula can provide pain relief and functional improvement in the treatment of fibular malunion. Further studies are needed to address long-term outcomes in this patient cohort.

The role of orthopaedic surgery in haemophilia: current rationale, indications and results.

The musculoskeletal problems of haemophilic patients begin in infancy when minor injuries lead to haemarthroses and haematomas.Early continuous haematological primary prophylaxis by means of the intravenous infusion of the deficient coagulation factor (ideally from cradle to grave) is of paramount importance because the immature skeleton is very sensitive to the complications of haemophilia: severe structural deficiencies may develop quickly.If primary haematological prophylaxis is not feasible due to expense or lack of venous access, joint bleeding will occur. Then, the orthopaedic surgeon must aggressively treat haemarthrosis (joint aspiration under factor coverage) to prevent progression to synovitis (that will require early radiosynovectomy or arthroscopic synovectomy), recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy).Between the second and fourth decades, many haemophilic patients develop articular destruction. At this stage the main possible treatments include arthroscopic joint debridement (knee, ankle), articular fusion (ankle) and total joint arthroplasty (knee, hip, ankle, elbow).Cite this article: EFORT Open Rev 2019;4:165-173. DOI: 10.1302/2058-5241.4.180090

The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease\u2014a cohort review

PurposeA formalised, universally accepted, radiological staging system of gleno-humeral joint osteonecrosis (ON) is lacking. Consequently, there is absence of a standardised management strategy. The aim is to propose a simple radiological staging system of gleno-humeral joint ON based on principles of the Association Research Circulation Osseous (ARCO) Society and review of clinical practice.MethodsA radiographic and clinical review of 45 patients with haematological-induced gleno-humeral ON was performed. The related management plans were analysed and categorised.ResultsAnalysis divided the disease into stages 0–4. Non-interventional management was the first-line treatment in stages 1–2. If unsuccessful, arthroscopic core decompression was performed. Patients with stages 3–4 were initially managed conservatively. If unsuccessful, in younger patients, arthroscopic joint debridement and capsular release was trialled. In older patients, or where this approach failed, shoulder arthroplasty was advised.ConclusionThe simple radiological classification assessed is useful to the provision of a standardised staged management strategy of gleno-humeral ON.

Clinical curative effect of repair surgery for treatment of articular cartilage injury

Objective: This study aims to determine the clinical efficacy of articular cartilage injury repair surgery. Methods: A total of 112 patients with knee articular cartilage injury who received treatment at our hospital from August 2015 to May 2017 were selected as research subjects. The patients were divided into control and experimental groups (56 patients in each group) through random even-odd number method and treated with arthroscopic joint debridement and arthroscopic microfracture repair surgery, respectively. Clinical treatment effect, HSS score, complication, and surgical result satisfaction were observed and compared between the two groups. Results: Patients in the experimental group exhibited significantly higher total effective rate than those in the control group (P<0.05). The HSS score in the experimental group was higher than that in the control group, and more patients in the former group showed HSS score higher than 85 or between 60-85 and less patients had HSS score less than 60 (P<0.05). Patients in the control group experienced less satisfaction on the result of surgery and higher complication incidence rate than those in the experimental group; the difference was statistically significant between the two groups (P<0.05). Conclusion: Arthroscopic microfracture surgery exerts satisfactory treatment effect for knee articular cartilage injury and can significantly improve patient satisfaction regarding surgery result, improve the articular function and physical action ability of patients, and reduce the incidence rate of complications. Hence, this technique is a feasible option and must be promoted for clinical application.

Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up.

Elbow osteoarthritis (OA) is a degenerative condition which in the advanced stage can severely impair joint mobility. Conservative treatment remains the first choice; surgery should be considered in case of failure in patients prepared to adhere to a demanding rehabilitation protocol. We assess the effectiveness of arthroscopic joint debridement and capsular release in a series of patients with primary and post-traumatic elbow arthritis. Forty-eight subjects (40 males, eight females; mean age 48 years) with a preoperative diagnosis of primary (19, 40 %) or post-traumatic OA (29, 60 %) were evaluated at a mean follow-up of 44 months. Outcome measures were active range of motion (ROM), pain score, Oxford elbow score (OES), and Mayo elbow performance score (MEPS). OA severity was graded into three classes (I-III) based on X-ray findings. Statistical significance was set at 5 %. At the final follow-up evaluation, active flexion/extension increased significantly (p < 0.01); pronation and supination improved, but the difference was not significant (p > 0.05). The pain score improved from 7.2 to 4.3 (p < 0.01). Both OES and MEPS improved significantly (p < 0.001). Patients with post-traumatic OA had better ROM (p = 0.0391) and clinical scores (OES, p = 0.011; MEPS, p = 0.010). ROM and clinical scores were lower but not significantly so in class II than in class I patients. A smooth coronoid and olecranon fossa was found in 38 (79 %) patients and a preserved ulnotrochlear joint space in 40 (80 %). Elbow OA has become more common as a result of earlier diagnosis and an increased number of acute injuries involving the joint. Arthroscopy is an effective technique to treat OA which provides the best results with the correct indications. Prospective studies are needed to help develop guidelines enabling selection of the best treatment option.

Die Behandlung moderater Kniegelenksarthrosen durch arthroskopisches Gelenkdebridement

This study is aimed to compare the effects of arthroscopic joint debridement over a 5-year period in a clearly defined patient population (only grade III knee osteoarthritis, history < 2 years). A total of 96 patients (50 male and 46 female) underwent arthroscopic knee debridement for knee OA. The main criteria for inclusion were osteoarthritis grade III (Kellgren-Lawrence score) and a maximal history of 2 years. The subjective complaints and the knee-related quality of life were estimated by the KOOS (knee injury and osteoarthritis outcome score). The score increased significantly within the 1 to 3 rd year post operation. After this interval the mean points of the score declined. But after 5 years the KOOS was higher in comparison to the baseline dates. Patients who had undergone conservative treatment at baseline had a significantly different KOOS than patients in the arthroscopy group. Over time, patients in the arthroscopy group had fewer complaints than patients in the conservative treatment group. In both groups, the results decreased over time. A total of 17 patients (17.2 %) needed a conversion to total endoprothetic replacement. The mean time-interval between index operation and conversion was 56.6 (95 % CI 54.4 - 58.4) months. In middle stages of knee OA, arthroscopic joint debridement can effectively reduce subjective complaints. Because this treatment does not stop the process of OA, the improvements decrease over time.

Letter regarding “The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis”

Letter regarding “The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis”

A Literature Synthesis Indicates Very Low Quality, but Consistent Evidence of Improvements in Function after Surgical Interventions for Primary Osteoarthritis of the Elbow

Background. Primary osteoarthritis of the elbow is a debilitating disease with an overall incidence of about 2%. Pain and reduced motion (ROM) lead to disability and loss of functional independence. Purpose. To critically review the literature on patient-related important functional outcomes (pain, ROMs and functional recovery) after surgery for primary OA of the elbow, utilizing the 2011 OCEBM levels of evidence. Design. A literature synthesis. Results. Twenty-six articles satisfied the inclusion and exclusion criteria; 25 of the studies were at level IV evidence, and 1 at level III. All three surgical techniques led to improvement in pain, ROM, and functional recovery in the short- and medium-term follow-up. Long-term follow-up results, available only for open joint debridement, showed recurrence of osteoarthritic signs on X-ray with minimal loss of motion. Recently, there seems to be an increased focus on arthroscopic debridement. Conclusion. The quality of research addressing surgical interventions is very low, including total elbow arthroplasty (TEA). However, the evidence concurs that open and arthroscopic joint debridement can improve function in patients with moderate-to-severe OA of the elbow. TEA is reserved for treating severe joint destruction, mostly for elderly individuals with low physical demands when other intervention options have failed.

The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis

Knee osteoarthritis is one of the most common orthopaedic diseases. Therapeutic options for this disease include conservative treatments and arthroscopic debridement and partial or complete replacement. This meta-analysis aimed to collect and analyse the available information on the effects of arthroscopic joint debridement related to the clinical outcomes, the required conversion to replacement and the factors for patient selection. A search for publications was performed in the PubMed, Cochrane and EMBASE medical databases. The primary search resulted in a total of 1,512 citations. The results from 30 papers were included in this study. The extracted dates were listed in a standardised protocol. The statistical evaluation was performed using Comprehensive Meta-analysis software (V2 Biostat, Englewood, NJ, USA). No randomised study that compared conservative and arthroscopic treatments for knee osteoarthritis was found. Most studies reported middle-term results after arthroscopic operations. The results of these studies showed excellent or good outcomes in more than 60 % of all patients. These results were correlated with a significant increase in the knee scores from baseline to follow-up; the standardised difference in means was 2.3 (CI 95 % 1.5-3.0, p < 0.001). The required conversion rate to replacement increased as the follow-up interval increased. The rates were as follows: 1 year-6.1 % (CI 95 %, 2.1-16.6 %), 2 years-16.8 % (CI 95 %, 10.2-26.3 %), 3 years-21.7 % (CI 95 %, 15.5-29.1 %) and 4 years-34.1 % (CI 95 %, 22.8-47.6 %). The mean survival time was 42.7 (CI 95 %, 14.5-71.1) months. Numerous factors influenced the outcome, including the radiological stage of the osteoarthritis and individual patient factors (e.g. time of history of osteoarthritis, weight and smoking). The local knee findings, such as axial dysalignment, missing effusion and massive crepitus, were also correlated with patient outcome. Arthroscopic joint debridement is a potential and sufficient treatment for knee osteoarthritis in a middle-term time interval. This procedure results in an excellent or good outcome in approximately 60 % of patients in approximately 5 years. Systematic review of studies, Level III.

Management of cartilage defects in the shoulder

Articular cartilage lesions of the glenohumeral joint are an especially difficult clinical problem to manage, particularly in the younger, more active patient. Left untreated, these lesions may progress in the long-term, leading to further pain and disability. While shoulder arthroplasty remains a viable option in older patients with glenohumeral arthritis, concerns over component longevity and loosening in younger patients make it less attractive in that age group. Arthroscopic joint debridement with loose body removal, often with capsular release, has been successful in select, more sedentary patients. More recent techniques, including autologous chondrocyte implantation (ACI), osteochondral grafting (allograft versus autograft), interpositional arthroplasty, and microfracture surgery, have been evaluated for use in the shoulder. These procedures have experienced success in weight bearing joints, including the knee and ankle. Despite the good clinical results in the shoulder with short-term follow-up reported in some small series, the treatment of chondral injuries in the glenohumeral joint remains a challenging problem.

Musculo-Skeletal Complications of Hemophilia

Prophylactic treatment from ages 2 to 18 years could avoid the development of hemophilic arthropathy if the concentration of the patient’s deficient factor is prevented from falling below 1% of normal. A review of the literature on the musculo-skeletal complications of hemophilia has been performed. Early treatment is of paramount importance because the immature skeleton is very sensitive to the complications of hemophilia; severe structural deficiencies may develop quickly. Major hemarthrosis (including joint aspiration) and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy. For the treatment of chronic haemophilic synovitis, radiosynovectomy should always be indicated as the first procedure. If, after three procedures with 6-month interval, radiosynovectomy fails, an arthroscopic synovectomy must be indicated. When advanced hemophilic arthropathy is present with severe disability, the aim should be to restore function. Arthroscopic joint debridement is an effective method to achieve this goal and can be considered to be an alternative to total joint arthroplasty in the younger age groups. Finally total joint arthroplasty can usually be relied upon to restore both mobility and function in a diseased joint. The potential benefits of joint arthroplasty must though always be weighed up against the long term sequelae, especially loosening and consequent revision surgery. A correct surgical haemostasis must be achieved by the infusion of factor concentrate at the right dose. Prophylactic treatment from ages 2 to 18 years could avoid the development of hemophilic arthropathy if the concentration of the patient ’s deficient factor is prevented from falling below 1% of normal. Major hemarthrosis, chronic hemophilic synovitis and the initial stages of hemophilic arthropathy should be treated aggressively to prevent hemophilic arthropathy. Finally total joint arthroplasty can usually be relied upon to restore both mobility and function in a diseased joint. A correct surgical haemostasis must be achieved by the infusion of factor concentrate at the right dose. doi:10.4021/jh18e

Aspects of current management: orthopaedic surgery in haemophilia

If continuous prophylaxis is not feasible due to expense or lack of venous access, we must aggressively treat major haemarthroses (including arthrocentesis) to prevent progression to synovitis, recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy). For the treatment of chronic haemophilic synovitis, radiosynovectomy should always be indicated as the first procedure. If, after three procedures with 6-month interval, radiosynovectomy fails, an arthroscopic synovectomy must be indicated. Between the second and fourth decades, many haemophilic patients develop joint destruction (arthropathy). At this stage possible treatments include alignment osteotomy, arthroscopic joint debridement, arthrodesis (joint fusion) and total joint arthroplasty. For the hip press-fit uncemented components (hemispherical acetabulum, flanged femoral stem, metal-to-polyethylene) are recommended whilst for the knee a posterior-stabilized (PS) cemented design is advised. Muscular problems must not be underestimated in haemophilia due to their risk of developing compartment syndromes (which will require surgical decompression) and pseudotumours (which will require surgical removal or percutaneous treatment). Regarding patients with inhibitors, the advent of APCCs and rFVIIa has made major orthopaedic surgery possible, leading to an improved quality of life for haemophilia patients. Concerning local fibrin seal, it is not always necessary to achieve haemostasis in all surgical procedures performed in persons with haemophilia. However, it could be a good adjunct therapy, mainly when a surgical field potentially will bleed more than expected (i.e. patients with inhibitors), and also in some orthopaedic procedures (mainly the surgical removal of pseudotumours).

The Hemophilic Joints

Recurrent hemarthroses in childhhood before the initiation of primary prophylaxis will result in joint damage after a decade or later. The best way that we have today to protecting against hemophilic arthropathy is primary prophylaxis. The decision to institute early full prophylaxis by means of a port (central venous access device) has to be balanced against the child’s bleeding tendency, the family’s social situation and the experience of the specific hemophilia center. The reported complication rates for infection and thrombosis have varied considerably from center to center. Risk of infection can be reduced by repeated education of patients and staff, effective surveillance routines and limitations on the number of individuals allowed to use the device. In discussing options for early therapy, the risks and benefits should be thoroughly discussed with the parents. From a practical point of view, primary prophylaxis together with synovectomy (radioactive, chemical, arthroscopic, or open) to avoid joint bleeding, can help halt hemophilic synovitis. Radiosynovectomy is a relatively simple, virtually painless and inexpensive treatment for chronic hemophilic synovitis, even in patients with inhibitors and must be the best choice for patients with persistent synovitis (which must be confirmed by US and/or MRI). Arthroscopic joint debridement may be indicated in younger hemophiliacs when there is relative preservation of the joint architecture and congruity, after the failure of three radiosynovectomies with a 6-month interval, and when joint replacement is not considered to be a viable alternative. Total joint arthroplasty should be indicated in hemophiliacs with severe joint pain and disability, including those who are HIV-positive. Hemophilia is a risk factor for infection after total joint arthroplasty. An extended period (2-3 weeks) of adequate hemostatic function is necessary to achieve normal healing after orthopedic procedures in hemophilia.

Editorial: Minimally invasive surgery options in managing shoulder osteoarthritis

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