Current Concepts in the Diagnosis and Management of Glenohumeral Osteoarthritis in the Young Patient

The treatment of young patients with advanced glenohumeral arthritis represents a surgical challenge for shoulder surgeons. Joint preserving surgical options such as comprehensive arthroscopic management are considered with less advanced arthritic change; however, more severe patterns of arthritis have been shown to exhibit poor outcomes after this treatment. Other humeral head and glenoid biologic resurfacing/interposition techniques have consistently shown high failure rates. Techniques in arthroplasty have advanced markedly, with the advent of pyrocarbon hemiarthroplasty demonstrating promise for longevity in early registry studies. If hemiarthroplasty is chosen, there has been much debate regarding management of the glenoid, including standard ream-and-run, as well as more corrective reaming, especially in the setting of glenoid deformity. Stemless arthroplasty and glenoid component fixation improvements have increased the appeal of anatomic total shoulder replacement in a younger population as well. Early data of inlay and inset glenoid components have shown some promise to reduce the rates of edge loading and glenoid loosening in anatomic total shoulder arthroplasty, which is relevant in young, active patients. Finally, indications for reverse shoulder arthroplasty continue to expand with implant longevity improving, making this a consideration in younger arthritic patients with rotator cuff tears or more advanced glenoid bone loss.