Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure.
BACKGROUND
Patient selection is critical when choosing between arthroscopic joint preservation and total shoulder arthroplasty in young patients with glenohumeral osteoarthritis (GHOA).


OBJECTIVE
To identify prognostic factors predictive of early failure in patients undergoing comprehensive arthroscopic management (CAM) for GHOA.


METHODS
Case-control study; Level of evidence, 3.


METHODS
A total of 107 shoulders in 98 patients with minimum 2-year follow-up who underwent CAM were identified and evaluated. All shoulders met clinical and radiographic criteria for total shoulder arthroplasty (TSA), but the patients opted for joint preservation with arthroscopic management. Radiographic and preoperative factors were analyzed to determine predictors of early failure, defined as progression to TSA within the study period.


RESULTS
There were 72 men and 26 women with a mean age of 52 years (range, 29-77 years). Seventeen (15.8%) of 107 shoulders progressed to TSA at a mean of 2 years (range, 0.46-8.2 years). Shoulder status for the rest had a mean follow-up of 3.9 years (range, 2-9.4 years). There were a number of radiographic features that were correlated with early failure. Patients who failed had significantly less preoperative joint space than did those who succeeded (1.3 vs 2.6 mm; P = .004). Higher Kellgren-Lawrence grades for osteoarthritis and age older than 50 were also associated with failure. Shoulders with Walch type B2 and C glenoid were significantly more likely to fail than were Walch types A1, A2, and B1 ( P < .05).


CONCLUSIONS
The CAM procedure has been shown to reliably improve pain and function in active patients with advanced GHOA; however, it is important to inform patients about the limitations of the procedure. Patients with less joint space and abnormal posterior glenoid shape were significantly more likely to progress to early failure.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Justin J
JJ
Mitchell
Steadman Philippon Research Institute, Vail, Colorado, USA.
Brent T
BT
Warner
Steadman Philippon Research Institute, Vail, Colorado, USA.
Marilee P
MP
Horan
Steadman Philippon Research Institute, Vail, Colorado, USA.
M Brett
MB
Raynor
Steadman Philippon Research Institute, Vail, Colorado, USA.
Travis J
TJ
Menge
Steadman Philippon Research Institute, Vail, Colorado, USA.
Joshua A
JA
Greenspoon
Steadman Philippon Research Institute, Vail, Colorado, USA.|The Steadman Clinic, Vail, Colorado, USA.
Peter J
PJ
Millett
D000328:Adult; D000368:Aged; D001182:Arthroscopy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000601:surgery*; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D017211:Treatment Failure
Walch glenoid morphology; arthroscopic management; glenohumeral osteoarthritis