Shoulder Arthritis: Treatment for Younger, Active Patients

When the shoulder joint is destroyed by arthritis total shoulder replacement is a treatment option that reliably relieves pain and restores function. Shoulder replacement has been a treatment option for patients with shoulder arthritis since the 1950s and decades of innovation and development have made shoulder replacement a very successful treatment option, with studies showing great clinical improvements in patients with shoulder arthritis of all ages. Currently, shoulder replacement is the third most common major joint replacement after hip and knee replacement. Nevertheless, because of increasing numbers of older individuals, and advances in shoulder replacements, and more physically active younger patients, the rate of shoulder replacement is increasing more rapidly than hip and knee. Total shoulder replacement surgery is considered the gold standard. The shoulder (the glenohumeral joint) is a ball-and-socket joint, with the ball (humeral head) of the arm bone fitting into the socket (glenoid) of the shoulder blade. (see Image 1) Articular cartilage covers the joint surfaces, and synovial joint fluid acts as a lubricant to eliminate friction and allow the ball to move smoothly in the socket. The normal shoulder joint is also highly dependent upon the surrounding rotator cuff tendons and muscles for stability, mobility, and strength. Arthritis causes loss of the smooth cartilage surface of the glenohumeral joint resulting in bone on bone joint contact with loss of range of motion and pain, affecting one’s ability to perform daily activities, work, and engage in recreation and sports. The pain also often interferes with sleep. Surgical treatment is an option when rest, medications, injections, and physical therapy do not help.

There are anatomic and reverse shoulder replacements. Anatomic shoulder replacement is most commonly used to treat patients with osteoarthritis. Reverse shoulder replacement is typically used to treat shoulders with arthritis and rotator cuff tearing.

When treating younger and active patients it is extremely important to consider the longevity of the implant after successful shoulder replacement surgery. One can anticipate that younger and very active patients will have greater expectations for activity and functional outcome from their shoulder replacement which will likely increase stress and wear on the prosthetic components. They often have goals to return to more physically strenuous activities including work and recreation and sports. In addition, younger patients have a longer life expectancy which is also risk factor for eventual failure of a total shoulder replacement. The socket component (glenoid) is the weak link and loosening is a common cause of later failure of an anatomic total shoulder replacement.

Humeral head replacement with glenoid reaming arthroplasty -also known as “Ream and Run” – was developed by Frederick Matsen, MD, at the University of Washington in Seattle as an alternative glenoid treatment that eliminates the risk of glenoid implant loosening. In this procedure, the glenoid bone is reamed in order to restore a smooth surface that matches the humeral head replacement, allowing for more motion and less pain.

Excellent results have been reported that show significant improvement in function and pain in younger and active patients. This procedure allows a return to physical activities without risk of glenoid loosening.

Dr Green has one of the largest experiences with Ream and Run in the world and is actively involved in the development of related implants and techniques.

Andrew Green, MD is the Chief of the Division of Shoulder and Elbow Surgery and a Professor of Orthopaedic Surgery in the Department of Orthopaedic Surgery of the Warren Alpert Medical School of Brown University. Dr. Green is a fellowship-trained specialist in problems of the shoulder, elbow and upper extremity. He is an internationally recognized expert in shoulder and elbow surgery and is certified by the American Board of Orthopaedic Surgery (www.ABOS.org) in Orthopaedic Surgery and Orthopaedic Sports Medicine. He is a member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, the American Shoulder and Elbow Surgeons, New England Shoulder and Elbow Surgeons, and the Orthopaedic Trauma Association. He has been recognized as a “Top Doctor” and is listed in the Guide to America’s Top Orthopedists, and Who’s Who in America.