Osteoarthritis of The Shoulder

Condition Overview

  • Primary osteoarthritis (OA) of the shoulder is a similar condition to that found in the hip and knee. Some patients have a genetic predisposition.
  • The secondary cause of OA can be posttraumatic, postsurgical, or a result of persistent or recurrent shoulder instability.
  • Common symptoms include pain with activity, pain at night, a decreased range of motion, and loss of function.​​

Imaging

  • Radiographs (X-Ray Imaging) will show narrowing of the joint space due to the wearing down of cartilage. The humeral head will often lose its round shape and become flattened. The bone beneath the cartilage becomes thickened (subchondral sclerosis). Osteophytes (bone spurs) are present about the glenoid (the socket) and humeral head. In advanced disease, the glenoid wears unevenly (more wear behind than in front) as a result of the humeral head sliding backwards and causing pressure in this region of the glenoid.

Non Surgical Treatment

  • Medications such as Non Sterioidal Anti-inflammatory Medications (NSAIDs) and analgesic medication may provide some symptomatic relief.
  • Injection of corticosteroid into the joint can provide substantial, but likely temporary, relief.
  • Physiotherapy and maintaining movement of the shoulder may provide some benefit. Excessive movement and overuse should be avoided in patients with advanced disease, because these exercises can exacerbate the symptoms.
  • Viscosupplementation injections may provide some pain relief in shoulder arthritis, but likely temporary relief.

Surgical Treatment

Reasons to consider surgery

  • Persistent symptoms despite nonsurgical management.
  • Substantial disability and loss of function impairing the ability to perform activities of daily living.

​Arthroscopic débridement

This procedure is controversial. It may be useful for removal of loose bodies, osteophytes and contracture release in the early stages of arthritis. It may be best suited for patients with relatively preserved motion, and some maintained joint space.

Total Shoulder Replacement (Arthroplasty)

  • Total shoulder arthroplasty (TSA) using a metallic humeral head coupled with a polyethylene (a type of plastic) glenoid prosthesis (the socket) is the treatment of choice for elderly patients with OA.
  • TSA provides reliable pain relief and range of motion.
  • The 10-year survival rate for the prosthesis is between 92% and 95%. This means after 10 years, 92% to 95% of patients have not required a revision procedure or removal of the implant. 
  • TSA should not be performed if there is a nonfunctioning deltoid muscle, irreparable rotator cuff tears, nerve injury, and severe glenoid bone loss.
  • A TSA performed in any of the following situation will fail due to loss of the ability to maintain a stable coupling of the implant. 

Reverse Total Shoulder Arthroplasty

  • Reverse TSA is used to treat shoulder arthritis associated with large, irreparable rotator cuff tears.
  • By reversing the relationship of the glenoid and the humeral head, the deltoid is placed at greater mechanical advantage to overcome the deficiency of the rotator cuff and elevate the shoulder.
  • It is primarily used to treat elderly patients with irreparable cuff tears and pseudoparalysis; however, the indications continue to expand and evolve.
  • Complication rates are substantially higher than those following TSA and include infection, dislocation, postoperative hematoma, acromion fracture, neurologic injury, intraoperative fracture, scapular notching, and deltoid pain.
  • ​In the past, 10-year survival rate is between 78% and 89%. However, the survival rate according to the Australian National Joint Replacement Registry is now approaching that of conventional Total Shoulder Arthroplasty. This can be put down to an improved understanding of the procedure as well as improvements in implant design.