Jesse A. McCarron, MD.
Current Orthopaedic Practice. July/August 2009. Vol. 20. No. 4. Pp. 382-387.
Younger adults are more likely to have had an injury earlier in life that has now resulted in trauma-induced arthritis. Infections, repetitive motions that cause microtrauma, and chondrolysis following arthroscopic shoulder surgery are other reasons why the joint cartilage wears away and arthritis sets in.
What can be done for the person with early onset of shoulder arthritis? Enough time has passed that we now know from short- to mid-range follow-up studies that artificial shoulder joint replacements isn’t always the perfect solution. The implant can wear out or loosen. Then it has to be replaced. That can mean a second surgery, loss of bone, further complications, and a major set back in motion and function.
Likewise, for hemiarthroplasties, the side that isn’t replaced eventually wears out, too. Or the side with the replacement implant develops problems with loosening or biomechanical wear and tear. The evidence supports delaying joint replacement by pursuing conservative (nonoperative) care for as long as possible.
Patients have a few choices. Physical therapy to build up strength around the shoulder and minimize stress or overload on the joint is one approach. Acupuncture, TNS, and NSAIDs may be helpful. Like any medication, NSAIDs have the potential to create adverse reactions, but can cause significant gastrointestinal complications.
When surgery is needed, every effort should be made to stimulate a healing response and save the joint, rather than remove and replace it, like Debridement. There are also various ways to repair and/or restore damaged cartilage, for example, autologous chondrocyte implantation (ACI) and osteochondral autologous transplant (OATS).
If conservative care and minimally invasive restorative procedures fail to bring the relief patients need, then joint replacement may be the next step.
Young patients with shoulder arthritis have quite a few procedures to choose from. But, given what we know about problems from these procedures, patients should be advised of all the pros and cons before deciding on the management approach that suits them best.