What helps with a degenerative glenoid rim?

Management of Degenerative Glenoid Rim

For degenerative glenoid rim conditions, total shoulder arthroplasty (TSA) is recommended over hemiarthroplasty as it provides better outcomes in terms of pain relief, function, and quality of life. 1, 2

Initial Conservative Management

• Viscosupplementation is a recommended option for treating glenohumeral osteoarthritis (GH OA) with degenerative glenoid rim, typically involving three weekly injections of hyaluronic acid preparations 2
• Physical therapy focusing on rotator cuff strengthening and proprioceptive control should be the initial management approach for patients with glenoid dysplasia and associated symptoms 3
• There is insufficient evidence to support or refute the use of intra-articular corticosteroid injections for GH OA 2

Surgical Management Algorithm

Patient Evaluation Factors

• Age is a critical consideration - concern exists about performing shoulder arthroplasty in patients under 50 years due to potential risks of increased prosthetic loosening and decreased survivorship 1, 2
• The extent of glenoid bone loss should be assessed through appropriate imaging, including CT scans or MRI, to determine the most appropriate intervention 1, 3

Arthroscopic Options for Early Disease

• There is insufficient evidence to recommend for or against arthroscopic treatments for GH OA 1, 2
• Arthroscopic options may be considered for younger patients with early-stage OA who are not candidates for arthroplasty 2
• For fragment-type lesions of the glenoid rim, arthroscopic or open reconstruction techniques can be successful 4

Arthroplasty for Advanced Disease

• Both TSA and hemiarthroplasty are options for treating GH OA, but TSA is strongly preferred 1, 2
• TSA provides better global health assessment scores and pain relief compared to hemiarthroplasty 1
• Hemiarthroplasty may be appropriate when the glenoid is naturally concentric or can be reamed to concentricity 1
• When performing TSA, either keeled or pegged all-polyethylene cemented glenoid components are recommended options 1

Management of Specific Scenarios

• For patients with GH OA and irreparable rotator cuff tear, TSA is not recommended 1, 2
• For small erosion-type glenoid lesions, soft-tissue procedures may be sufficient 4
• For large erosion-type lesions with significant bone loss, bone-grafting procedures (autologous iliac crest or coracoid transfer) may be necessary to restore glenoid concavity and shoulder stability 4, 5
• Iliac crest graft glenoid augmentation has shown good long-term outcomes for glenoid deficiency, with a mean Oxford Shoulder Instability Score of 18.1 points at 9.2 years follow-up 5

Important Considerations and Pitfalls

• Surgeon experience is crucial - surgeons who perform fewer than two shoulder arthroplasties per year should avoid performing these procedures to reduce immediate postoperative complications 1
• Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation can result in excellent clinical outcomes with very low rates of residual instability, though asymptomatic radiographic osteoarthritis may occur in approximately 25% of patients 6
• Glenoid retroversion of >10° may be a risk factor for failure following soft-tissue-only procedures for symptomatic glenoid dysplasia 3
• In severe glenoid dysplasia, the combination of bone deficiency and retroversion makes glenoid osteotomy extremely challenging 3

Follow-up and Monitoring

• Regular radiographic follow-up is essential to monitor for complications such as prosthetic loosening, glenohumeral instability, and progressive osteoarthritis 1
• Patients should be monitored for potential complications including prosthetic loosening (particularly with glenoid components in TSA), glenohumeral instability, and progressive wear 1