Is there a surgery to fix arthritis without a shoulder replacement?

Surgical Options for Shoulder Arthritis Without Replacement

For patients with shoulder arthritis, there are limited surgical options beyond shoulder replacement, with arthroscopic procedures showing insufficient evidence to recommend them as definitive treatments for glenohumeral osteoarthritis. 1

Available Surgical Options

Arthroscopic Procedures

• Arthroscopic debridement - May provide temporary relief but lacks strong evidence
• Capsular release - Can help with stiffness associated with arthritis
• Synovectomy - May help in inflammatory arthropathies
• Osteoplasty of the humeral head - Can address bone spurs
• Microfracture techniques - Limited evidence for effectiveness 2, 3

The American Academy of Orthopaedic Surgeons (AAOS) is unable to recommend for or against arthroscopic treatments for glenohumeral osteoarthritis due to insufficient evidence (Level V evidence, Grade I recommendation). 1

Other Non-Replacement Surgical Options

• Open debridement - Insufficient evidence to recommend for or against
• Interpositional arthroplasty - Using soft tissue grafts between joint surfaces
• Osteoarticular allograft - Using donor bone and cartilage
• Autograft procedures - Using patient's own tissue 1

Patient Selection Considerations

Arthroscopic procedures may be considered in:

• Younger patients (<50 years) where there are concerns about prosthetic loosening and decreased survivorship with replacement 1, 4
• Patients with early-stage arthritis whose symptoms aren't severe enough to warrant arthroplasty 1
• Athletes wishing to delay arthroplasty 2
• Patients with comorbidities who may not tolerate more extensive surgery 2

Evidence Quality and Outcomes

The evidence supporting non-replacement surgical options is limited:

• No high-quality randomized trials comparing arthroscopic procedures to other treatments 5
• Most studies suggest better outcomes when intervention occurs early in the disease course 2
• Short-term results for comprehensive arthroscopic management show promise for pain reduction but long-term outcomes are uncertain 3

Treatment Algorithm

1. First line: Non-surgical management including physical therapy, NSAIDs, and possibly intra-articular injections 1, 4

2. When considering surgery:

   • For younger patients (<50 years): Consider arthroscopic options first
   • For patients with mechanical symptoms: Arthroscopic debridement may provide temporary relief
   • For patients with inflammatory arthritis: Consider arthroscopic synovectomy

3. If arthroscopic options fail: Consider shoulder replacement options (TSA or hemiarthroplasty) 1

Important Caveats

• Arthroscopic lavage and debridement should not be routinely offered unless there is a clear history of mechanical locking 1
• The AAOS specifically notes that there is insufficient evidence to recommend for or against open debridement and non-prosthetic arthroplasty options 1
• While arthroscopic procedures have lower morbidity and complication rates than replacement, their effectiveness for treating the underlying arthritis is limited 2

Conclusion

While arthroscopic and other non-replacement surgical options exist for shoulder arthritis, the evidence supporting their use is limited. These procedures may provide temporary symptom relief but do not address the underlying joint degeneration as effectively as shoulder replacement.