title: Is there sufficient evidence to support intervention to manage shoulder arthritis?
abstract: BACKGROUND
  We explore the nature, extent and validity of research studies concerning the management of shoulder arthritis to identify whether current management recommendations are adequate.
  
  
  METHODS
  A full electronic search for relevant studies published between 2002 and 2012 was performed. The search focused on level 1 and level 2 studies. Full texts of selected articles were retrieved and assessed for quality against validated criteria.
  
  
  RESULTS
  Four hundred and eleven studies were identified on the initial search and screened. Sixteen studies were selected for inclusion in the review. The studies identified were unable to provide a clear indication of best intervention for shoulder arthritis. The inclusion of a range of shoulder pathologies in some studies and the diversity in outcome measures used made it difficult for systematic reviews to effectively pool data. Better outcomes have been shown with total shoulder replacement over hemiarthroplasty for shoulder osteoarthritis; however, primary studies were often of limited quality. Sparse evidence is available for all other interventions, regardless of whether operative or non-operative.
  
  
  CONCLUSIONS
  The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. More rigorous and robust primary studies are needed to guide clinical practice on the best interventions for arthritis of the shoulder.
authors: James Cook University Hospital, Marton Road, Middlesborough, UK.
authors: Damian
authors: D
authors: Bull
authors: James Cook University Hospital, Marton Road, Middlesborough, UK.
authors: Andrew
authors: A
authors: Tai Kie
authors: James Cook University Hospital, Marton Road, Middlesborough, UK.
authors: Birgit
authors: B
authors: Hanusch
authors: Royal Gwent Hospital, Newport, UK.
authors: Rohit
authors: R
authors: Kulkarni
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
authors: Jonathan
authors: J
authors: Rees
authors: James Cook University Hospital, Marton Road, Middlesborough, UK.
authors: Amar
authors: A
authors: Rangan
keywords: hemiarthroplasty; osteoarthritis; reverse; shoulder; tenodesis; total