Shoulder joint preservation surgeries in adults

Abstract Background Shoulder preservation surgery encompasses various joint-sparing procedures aimed at delaying arthroplasty in patients with glenohumeral osteoarthritis (OA). This systematic review synthesises and discusses the evidence on shoulder joint-preservation surgeries for the management of glenohumeral arthritis in adults. Methods This systematic review was conducted following the PRISMA 2020 guidelines and the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Web of Science, and Embase was conducted in June 2025 to identify clinical studies evaluating shoulder joint-preservation surgeries for the management of glenohumeral arthritis in adults. Only studies reporting a minimum follow-up of six months were considered. Results Data from nine studies (333 patients, 335 shoulders) were analysed. The mean age ranged from 41.7 to 57.5 years, and 28.8% (96 of 333 patients) were women. The length of the follow-up ranged from 6.0 to 123.7 months. The reported surgical interventions primarily involved arthroscopic debridement procedures, often combined with capsular release or subacromial decompression, as well as microfracture with or without biological augmentation and glenoid resurfacing using dermal allografts. The complication rate was 2% (6 of 246 patients), and the infection rate was 0.5% (1 of 199 patients). 22.4% (71 of 317) of patients underwent surgical revision. 19.6% (62 of 317) of patients progressed to total shoulder arthroplasty (TSA), with a reported mean time to conversion of 8.0 to 56.4 months. Conclusion Shoulder joint preservation surgeries may alleviate symptoms of glenohumeral OA in adults. Nonetheless, available evidence is constrained by heterogeneity in study design, limited patient numbers, and the absence of comparative data. High-quality prospective studies are needed to refine patient selection criteria and establish evidence-based treatment recommendations.