Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, October 28, 2009
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Figure 3 - Glenoid bone spurs: The figure on the left shows bone spurs at the bottom of the joint. The figure on the right shows that the ball is not centered and has worn down the back part of the socket.
Review of the condition
Characteristics of arthritis of the shoulder
Arthritis of the shoulder is a condition in which the cartilage normally covering the joint surfaces is lost.
Individuals with shoulder arthritis usually notice pain, stiffness
and loss of the ability to use the shoulder for their usual activities.
Commonly, they have difficulty sleeping on the affected shoulder and
limited range of motion. Some people with arthritis notice a grinding
feeling when the shoulder is moved. Shoulder arthritis usually gets
worse over time, but the rate of this progression varies widely.
Types
Shoulder arthritis may be of several types, including osteoarthritis (or degenerative joint disease), rheumatoid arthritis, arthritis after injury (traumatic arthritis), arthritis after previous surgery (for example, capsulorrhaphy arthropathy), and arthritis associated with rotator cuff disease (known as cuff tear arthropathy). Arthritis may also follow infection; this is known as septic arthritis. If the ball of the shoulder joint (humeral head) dies from lack of circulation, a condition known as avascular necrosis (or osteonecrosis) of the shoulder may result.Similar conditions
Shoulder arthritis must be distinguished from rotator cuff disease,
frozen shoulder, and neck arthritis, each of which may produce similar
symptoms. Rotator cuff tears usually cause pain and weakness, but
stiffness is less common. Frozen shoulder is characterized by shoulder
stiffness, but the X-rays are usually normal. Neck arthritis may cause
shoulder pain and weakness that is worse when the head is held in
certain positions.Incidence and risk factors
Although not as common as rotator cuff disease, shoulder arthritis is
among the most prevalent causes of shoulder pain and loss of function.
Arthritis of the shoulder joint is less common than arthritis of the
hip or knee. Individuals with arthritis in one joint are more likely to
get it in another joint.Diagnosis
A physician diagnoses shoulder arthritis by reviewing the patient's
history, performing a thorough physical examination of the joint and
taking the proper X-rays. The examination of an arthritic shoulder
reveals stiffness and roughness of the joint.
X-rays of the shoulder reveal the contour of the joint surfaces and
the status of the cartilage space between them. X-rays of an arthritic
shoulder usually show a narrowing of the space between the ball and
socket--often to the point that bone is touching bone. The left side of
figure 3 shows bone spurs at the bottom of the joint. The right side of
figure 3 shows that the ball is not centered and has worn down the back
part of the socket. These findings indicate that the normal cartilage
has been destroyed. X-rays do not show the soft tissues, such as scar
tissue, that may also be limiting joint motion.
It is essential that the shoulder surgeon establish the diagnosis of arthritis before shoulder joint replacement is considered.
Medications
Medications may be helpful in managing arthritis. In the case of
rheumatoid arthritis, specific drugs may treat the inflammation that
destroys the cartilage. Some of these medications are administered by
injection and others by mouth. Some individuals take anti-arthritic
medications for their entire lives. These medications can be quite
helpful, but there may be side effects. These medications should be
taken under the close supervision of a rheumatologist or other
physician experienced in their use. In other types of arthritis,
anti-inflammatory drugs may lessen the pain, but do not change the
course of the condition. It is important that the patient be aware of
the possible side effects of these medications, including stomach
irritation, kidney problems and bleeding. Injections of steroids
(cortisone) or lubricants (such as hyaluronic acid) into the shoulder
have not been demonstrated to have lasting benefit and carry some risk
of infection.
For each medication, patients should learn:
- the risks,
- possible interactions with other drugs,
- the recommended dosage, and
- the cost.
Exercises
If exercises are not too painful, they may be helpful in maintaining
the flexibility and strength of joints with arthritis. In most cases
these exercises can be done in the patient's home with minimal
equipment. Shoulder exercises are best performed gently several times a
day on an ongoing basis. Often the exercises will help during the
earlier phases of the condition. The exercises are not dangerous if
they are performed gently. The diagrams show two examples of these
exercises.
Figure 4 shows a patient using the left arm to help lift the stiff
right shoulder in a forward direction. Figure 5 shows a patient using
the left arm to gently stretch the stiff right arm in external rotation
using a yardstick.
Sometimes other types of therapy are used by physical therapists.
Patients should learn the possible risks of these approaches as well as
their costs and anticipated effectiveness.
Possible benefits of non-prosthetic glenoid arthroplasty
With proper rehabilitation, shoulder hemiarthroplasty with
non-prosthetic glenoid arthroplasty restores lost function to arthritic
shoulder joints. By removing the damaged joint surfaces, this procedure
allows the shoulder to move in a smooth and stable manner. In
experienced, hands, this procedure can also address the restricting
scar tissue that frequently accompanies arthritis and contributes to
pain and stiffness.
Both total shoulder replacement surgery and non-prosthetic glenoid
arthroplasty can improve the mechanics of the shoulder, but cannot make
the joint as good as it was before the onset of arthritis. In many
cases, the tendons and muscles around the shoulder have been weakened
from prolonged disuse before the operation. It can often take months of
gentle exercises before the shoulder achieves maximum improvement.
The effectiveness of the procedure depends on the health and
motivation of the patient, the condition of the shoulder, and the
expertise of the surgeon. Strict adherence to the rehabilitation
program maximizes the chances of a good result from non-prosthetic
glenoid arthroplasty. Maintaining general health, fitness and nutrition
as well as abstinence from cigarette smoking all improve the chances of
success. The greatest improvements are in the ability of the patient to
sleep, to perform activities of daily living, and to perform
non-contact recreational activities.
Surgery for Arthritis of the Shoulder at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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