Treatment of Glenohumeral Joint Space Narrowing
For patients with glenohumeral joint space narrowing indicating osteoarthritis, total shoulder arthroplasty is superior to hemiarthroplasty and represents the definitive surgical treatment when conservative measures fail. 1
Treatment Algorithm
Initial Conservative Management
Treatment should be dictated by patient age, severity of symptoms, radiographic findings, and medical comorbidities 1. However, the evidence base for nonsurgical treatment is notably weak 1.
Conservative options include:
- Physical therapy - Commonly recommended but lacks high-quality evidence supporting its efficacy 1
- Pharmacotherapy - Extrapolated from hip and knee osteoarthritis literature, though specific evidence for glenohumeral OA is limited 1
- Injectable corticosteroids - Evidence is insufficient to recommend for or against their use (Grade I recommendation) 1
- Viscosupplementation - Weak recommendation as a treatment option 1
Important caveat: The AAOS guideline explicitly states that "barely any data exist to guide nonsurgical treatment" of glenohumeral osteoarthritis 1. This means conservative management is largely based on extrapolation from other joints rather than shoulder-specific evidence.
Surgical Intervention
When conservative treatment fails, surgical options should be considered based on specific patient factors:
Primary Surgical Recommendation
- Total shoulder arthroplasty (TSA) is preferred over hemiarthroplasty - This is the single moderate-strength recommendation from the AAOS guidelines 1
- TSA provides superior clinical outcomes compared to hemiarthroplasty for advanced glenohumeral osteoarthritis 1
Critical Contraindications
TSA should NOT be performed in patients with:
- Irreparable rotator cuff tears - This is a consensus recommendation from the AAOS 1
- In these cases, reverse total shoulder arthroplasty may be considered as an alternative 1
Surgical Quality Considerations
- Avoid surgeons performing fewer than 2 shoulder arthroplasties per year - Weak recommendation to reduce immediate postoperative complications 1
- Use keeled or pegged all-polyethylene cemented glenoid components (weak recommendation) 1
Alternative Surgical Options
Other surgical approaches mentioned include arthroscopy, open debridement, and nonprosthetic/biologic interposition arthroplasty, though evidence supporting these is limited 1
Perioperative Management
- Use mechanical and/or chemical venous thromboembolism prophylaxis for all shoulder arthroplasty patients (consensus recommendation) 1
Postoperative Rehabilitation
- Physical therapy following shoulder arthroplasty is commonly practiced, but no high-quality studies demonstrate whether it improves outcomes (Grade I recommendation) 1
Common Pitfalls to Avoid
Key clinical considerations:
- Do not assume conservative treatments are evidence-based - Most recommendations are extrapolated from hip/knee literature rather than shoulder-specific studies 1
- Pre-operative imaging is essential - Evaluate glenoid morphology, bone loss, retroversion, and bone quality before arthroplasty 2
- Recognize the high complication rate - Shoulder arthroplasty complications occur in up to 39.8% of cases, with revision rates up to 11% 1
- Most common complications differ by procedure type:
Evidence Quality Note
The AAOS guideline work group concluded that "the quality of scientific data on management of glenohumeral OA can be significantly improved" 1. Of 16 recommendations addressed, nine are inconclusive, highlighting the substantial evidence gaps in this field 1.