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Published by American Academy of Orthopaedic Surgeons · AAOS Strength of Recommendation (Strong, Moderate, Limited, Consensus)
This document addresses the management of patients with primary glenohumeral joint osteoarthritis, evaluating the effectiveness of both non-surgical and surgical approaches to minimize dysfunction and pain.
Key Takeaways
Strong evidence supports that there is no benefit to the use of hyaluronic acid in the treatment of glenohumeral joint osteoarthritis.
Strong evidence suggests that obese patients with glenohumeral osteoarthritis do not experience an increase in the rate of early post-operative complications.
Strong evidence supports that gender/sex is not associated with better or worse post-operative outcomes.
Strong evidence suggests that patients with glenohumeral joint osteoarthritis who have more comorbidities experience higher rates of early post-arthroplasty complications.
Strong evidence supports that anatomic total shoulder arthroplasty demonstrates more favorable function and pain relief in the short- to mid-term follow-up when compared to hemiarthroplasty for the treatment of glenohumeral osteoarthritis.
Strong evidence supports that the clinician may utilize pegged or keeled glenoid components in patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff. Pegged components demonstrate less radiolucent lines, but the effect on clinical outcomes and survivorship are unclear.
Moderate evidence supports that older age at the time of surgery is associated with lower revision rates.
Moderate evidence suggests that smoking is associated with inferior post-operative outcomes.
Moderate quality evidence suggests that, while both higher and lower pre-operative functioning patients with glenohumeral joint osteoarthritis will likely experience improvement following arthroplasty, patients with higher pre-operative function may experience less functional improvement.
Moderate evidence suggests that depression is associated with inferior post-operative outcomes in patients with glenohumeral joint osteoarthritis undergoing arthroplasty.
Moderate evidence supports that surgeons not use metal-backed cementless glenoid components.
Moderate quality evidence supports that surgeons can utilize subscapularis peel, lesser tuberosity osteotomy, or tenotomy when performing shoulder arthroplasty.
Limited evidence supports that clinicians may utilize stemmed, stemless or resurfacing prosthesis for patients with glenohumeral joint osteoarthritis undergoing total or hemi-arthroplasty.
In the absence of reliable evidence, it is the opinion of the work group that physical therapy may benefit select patients with glenohumeral joint osteoarthritis.
In the absence of reliable evidence, it is the opinion of the work group that clinicians may prescribe physical therapy in patients following shoulder arthroplasty.
In the absence of reliable evidence, it is the opinion of the work group that injectable biologics, such as stem cells or platelet-rich plasma, cannot be recommended in the treatment of glenohumeral osteoarthritis.
In the absence of reliable evidence, the work group cannot recommend for or against the use of the following: Acupuncture, Dry needling, Cannabis, Cannabodiol (CBD) oil, Capsaicin, Shark cartilage, Glucosamine and chondroitin, Cupping, Transcutaneous Electrical Nerve Stimulation (TENS)
In the absence of reliable evidence, it is the opinion of the work group that opioids not be prescribed as routine and long-term pain management of glenohumeral osteoarthritis.
In the absence of reliable evidence, it is the opinion of the work group that non-prosthetic surgical options may or may not provide short-term benefit for patients with glenohumeral joint osteoarthritis.
In the absence of reliable evidence, it is the opinion of the work group that patients with glenohumeral osteoarthritis undergoing arthroplasty should be imaged with axillary and true AP (Grashey view) radiographs, with advanced imaging performed at the discretion of the clinician.
In the absence of reliable evidence, it is the opinion of the work group that either cemented or cementless stems can be utilized in the treatment of patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff.
In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use either anatomic total shoulder arthroplasty (TSA) or reverse TSA for the treatment of glenohumeral joint osteoarthritis in select patients with excessive glenoid bone loss and/or rotator cuff dysfunction.
In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use polyethylene-metal hybrid glenoid components or all-polyethylene components during total shoulder arthroplasty for treatment of glenohumeral joint osteoarthritis.
In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may consider concomitant biceps tenodesis or tenotomy during shoulder arthroplasty.
In the absence of reliable evidence, it is the opinion of the workgroup that utilization of tranexamic acid during shoulder arthroplasty may result in reduced blood loss and reduced risk of blood transfusion.
In the absence of reliable evidence, it is the opinion of the workgroup that, for patients with small isolated, repairable supraspinatus tears, clinicians can perform anatomic total shoulder arthroplasty.
In the absence of reliable evidence, it is the opinion of the workgroup that same-day discharge is an option after shoulder arthroplasty in select patients.
In the absence of reliable evidence, it is the opinion of the workgroup that either continuous cryotherapy or cold packs can be used following shoulder arthroplasty.
In the absence of reliable evidence, it is the opinion of the workgroup that multimodal pain management strategies or non-opioid individual modalities can provide added benefit for postoperative pain management following shoulder arthroplasty.
Clinical Topic
Glenohumeral Joint Osteoarthritis
Objectives
To provide evidence-based treatment recommendations derived from a systematic review of the best current available evidence in the literature for the management of glenohumeral joint osteoarthritis.
Target Patient Population
Patients with glenohumeral joint osteoarthritis
Target Providers
Therapeutic Area
Musculoskeletal SystemGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: AAOS Strength of Recommendation (Strong, Moderate, Limited, Consensus)
Evidence Distribution
Evidence Levels
Recommendation Strength
Contraindications
Difficulty
advanced
Learning Paths