ROSEMONT, Ill., Nov. 16, 2018 /PRNewswire/ -- A new review
article published in the Journal of the American Academy of
Orthopaedic Surgeons (JAAOS) finds arthroscopic (joint replacement
or reconstruction) management could be a promising option for
young, active patients diagnosed with GHOA.
Primary glenohumeral osteoarthritis (GHOA) is a common type of
painful and debilitating shoulder osteoarthritis (OA). Shoulder OA
leads to upper body dysfunction in over 20 million Americans.
People with GHOA may have trouble throwing, swimming and lifting
their arms to do everyday tasks. They often have pain centered in
the back of their shoulder. As it progresses, shoulder arthritis
pain may interrupt sleep. This condition can be especially
frustrating for younger, active patients.
"Total shoulder replacement is not ideal for young, high-demand
patients with GHOA," explains Peter J.
Millett, MD, lead author of the study and orthopaedic
surgeon at the Steadman Clinic. "Instead patients under 50 years
old or select active patients up to age 65 with advanced GHOA who
haven't experienced adequate relief from nonsurgical treatment may
experience the greatest benefit from arthroscopic management."
Over the last 15 years, Dr. Millett has been working on an
arthroscopic approach to treat GHOA that preserves the shoulder
joint, decreases pain and improves function. This approach, the
Comprehensive Arthroscopic Management (CAM) procedure, is also now
being successfully utilized by other orthopaedic shoulder
specialists for some patients to treat shoulder osteoarthritis.
Outcomes for patients with advanced symptomatic GHOA who
underwent CAM procedures include:
- Significantly improved ability to complete daily activities and
reduced pain and instability as reported by both patients and
doctors (known as the American Shoulder and Elbow Surgeons Shoulder
Score (ASES));
- Significant rates of preventing total shoulder arthroplasty
(TSA) at one, two, three and five years following CAM procedures;
and,
- Median patient satisfaction rate of nine out of 10 five years
after CAM procedures among patients who did not need TSA.
Osteoarthritis is the most frequent cause of disability in
the United States. Cartilage
breaks down, and the body's healing process can ruin the smooth
joint surfaces needed for typical movement. Related inflammation
also limits motion. Doctors have multiple surgical and non-surgical
treatment options for osteoarthritis. Physical therapy, home
exercise, cortisone injections, and anti-inflammatory medications
such as ibuprofen may offer relief for osteoarthritis, but the
scientific literature supporting these approaches is limited.
Despite this, Dr. Millet notes that most doctors will try one or
more of these methods before suggesting surgery.
If nonsurgical efforts fail, removing damaged cartilage or bone
(debridement) or arthroplasty are potential next steps. However,
each of these approaches have potential downsides, including long
recovery times, surgical risks and acceleration of the arthritis
with more pain, stiffness and dysfunction. With arthroplasty,
additional risks related to the artificial joint may include pain,
dysfunction and wearing out of implants over time.
In search of a solution to address these shortcomings,
orthopaedic surgeons have identified new combinations of treatments
that preserve joints and delay or avoid arthroplasty. Dr. Millet
and his colleagues combined new and existing procedures to treat
this specific arthritis.
"The CAM procedure is a minimally invasive surgery that removes
mechanical irritants from the joint, reshapes the humerus to make
it round again and also to decrease any impingement on the adjacent
nerves," says Dr. Millett. "The overall goal is to achieve a
synergistic benefit with pain relief and functional restoration,
without burning bridges for future surgeries, all while delaying
joint replacement or perhaps even avoiding it altogether."
Advantages of arthroscopic management as compared to total
shoulder arthroplasty include delaying or avoiding arthroplasty,
preserving the joint, and preserving future treatment options.
Disadvantages of CAM include that the procedures are technically
demanding, long-term outcomes remain unknown, and that there is no
guarantee a patient will not need arthroplasty in the future.
"The human and economic costs of shoulder arthritis are
substantial and conventional treatment has significant
shortcomings. This new, more tailored approach is potentially good
news for GHOA sufferers. "Long-term data of patients who have
undergone the CAM procedure show promising, but not perfect,
results," Dr. Millett concludes.
The full study is available at:
https://bit.ly/2DdneyI
More information about arthritis of the shoulder is at
OrthoInfo
More information about the
AAOS and JAAOS
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Disclosures
From the Steadman Philippon Research
Institute (Dr. Millett and Dr. Fritz), and the Steadman Clinic,
Steadman Philippon Research Institute (Dr. Frangiamore and Dr.
Mannava), Vail, CO. Dr. Millett or
an immediate family member has received royalties from Arthrex and
MedBridge; serves as a paid consultant to Arthrex; has stock or
stock options held in Game Ready and VuMedi; and has received
research or institutional support from Arthrex, Össur, Siemens, and
Smith & Nephew. Dr. Fritz or an immediate family member has
received research or institutional support from Arthrex, Össur,
Smith & Nephew, and Vail Valley Medical Center. Dr. Mannava or
an immediate family member serves as a board member, owner,
officer, or committee member of the Arthroscopy Association of
North America. Neither Dr.
Frangiamore nor any immediate family member has received anything
of value from or has stock or stock options held in a commercial
company or institution related directly or indirectly to the
subject of this article. JAAOS - Journal of the American Academy of
Orthopaedic Surgeons: November 1,
2018 - Volume 26 - Issue 21 - p 745–752
doi: 10.5435/JAAOS-D-17-00214
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content:http://www.prnewswire.com/news-releases/patients-with-shoulder-arthritis-have-new-options-to-avoid-risks-of-total-shoulder-replacement-300752364.html
SOURCE American Academy of Orthopaedic Surgeons