Review Question - QID 4890

This patient has end-stage glenohumeral osteoarthritis (GH OA). According to the AAOS CPG, total shoulder arthroplasty (TSA) is recommended using an all-polyethylene cemented glenoid component.

TSA is indicated for cases of end-stage GH OA. It is preferred to hemiarthroplasty. It is contraindicated in cases with insufficient glenoid bone stock (glenoid wear to the level of the coracoid), rotator cuff arthropathy or irreparable cuff tears and deltoid dysfunction. It provides good pain relief and has good survival at 10 years (>90%).

Radnay et al. performed a systematic review involving 1952 patients comparing TSA with humeral head replacement (HHR). They found that TSR provided greater pain relief, range of motion, patient satisfaction, and had lower revision rates. They recommend TSA over HHR for GH OA.

Izquierdo et al. described the AAOS Clinical Practice Guidelines (CPG) regarding treatment of GH OA. This is summarized in Illustration A.

Figures A and B show end-stage GH OA with large osteophytes and subchondral sclerosis. There is significant glenoid wear and posterior subluxation (Walch B glenoid deformity). Illustration A is a table summarizing the AAOS CPG on treatment of GH OA. Illustration B shows a CTA humeral component. It is not paired with a glenoid component.

Incorrect Answers:
Answer 1: The AAOS CPG does not recommend humeral head replacement arthroplasty (resurfacing).
Answer 2: Although the AAOS CPG recommends both hemiarthroplasty and TSA as options, TSA is preferred.
Answer 3: The AAOS CPG does not recommend use of a CTA humeral component.
Answer 4: The AAOS CPG does not recommend the use of metal-backed glenoid components. Metal-backed glenoids have higher rates of revision than all-polyethylene glenoids.