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Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review.
Arthroscopy. 2020 Jul; 36(7):2010-2021.A

Abstract

PURPOSE

To perform a systematic review of the literature describing outcomes, surgical procedures, and rates of conversion to arthroplasty after arthroscopic debridement of symptomatic primary glenohumeral osteoarthritis.

METHODS

The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried. Articles without sufficiently detailed descriptions of the debridement procedure, those primarily describing cartilage resurfacing procedures, or those that did not report any postoperative outcomes were excluded. Study design, patient demographic characteristics, operative details, imaging findings, patient-reported outcomes, and rates of conversion to arthroplasty were compiled and reported. Assessment of bias was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria.

RESULTS

A total of 371 patients (382 shoulders) in 8 studies were included. Patient sample sizes ranged from 8 patients (9 shoulders) to 98 patients (107 shoulders), and the samples were predominantly comprised of male patients (range, 57.1%-100%). The mean age and follow-up period ranged from 38 to 59 years and from 13.7 to 46.8 months, respectively. In studies reporting both preoperative and postoperative outcomes, improvements were found in American Shoulder and Elbow Surgeons scores (range, 8.6-22) and visual analog scale scores for pain (range, 0.4-3.8). There was significant heterogeneity (I2 = 75%) in the rates of conversion to shoulder arthroplasty, which ranged from 4% to 42.4%, with the mean time to conversion ranging from 9 to 56 months. Study heterogeneity improved with subgroup analyses based on minimum duration of follow-up (>2 years) and preoperative radiographic inclusion criteria.

CONCLUSIONS

Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. Despite variability in procedures and rates of subsequent conversion to arthroplasty, arthroscopic treatment appears to provide symptom relief and functional improvements in carefully selected patients. However, the longevity of improvement remains unclear, with studies including a longer duration of follow-up showing potential regression of symptom relief and increased rates of conversion to arthroplasty.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and IV studies.

Authors+Show Affiliations

Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: Jorge.chahla@rushortho.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32151663

Citation

Williams, Brady T., et al. "Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: a Systematic Review." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 36, no. 7, 2020, pp. 2010-2021.
Williams BT, Beletsky A, Kunze KN, et al. Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. Arthroscopy. 2020;36(7):2010-2021.
Williams, B. T., Beletsky, A., Kunze, K. N., Polce, E. M., Cole, B. J., Verma, N. N., & Chahla, J. (2020). Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 36(7), 2010-2021. https://doi.org/10.1016/j.arthro.2020.02.036
Williams BT, et al. Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: a Systematic Review. Arthroscopy. 2020;36(7):2010-2021. PubMed PMID: 32151663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. AU - Williams,Brady T, AU - Beletsky,Alexander, AU - Kunze,Kyle N, AU - Polce,Evan M, AU - Cole,Brian J, AU - Verma,Nikhil N, AU - Chahla,Jorge, Y1 - 2020/03/06/ PY - 2019/10/20/received PY - 2020/01/24/revised PY - 2020/02/26/accepted PY - 2020/3/11/pubmed PY - 2020/3/11/medline PY - 2020/3/11/entrez SP - 2010 EP - 2021 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 36 IS - 7 N2 - PURPOSE: To perform a systematic review of the literature describing outcomes, surgical procedures, and rates of conversion to arthroplasty after arthroscopic debridement of symptomatic primary glenohumeral osteoarthritis. METHODS: The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried. Articles without sufficiently detailed descriptions of the debridement procedure, those primarily describing cartilage resurfacing procedures, or those that did not report any postoperative outcomes were excluded. Study design, patient demographic characteristics, operative details, imaging findings, patient-reported outcomes, and rates of conversion to arthroplasty were compiled and reported. Assessment of bias was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria. RESULTS: A total of 371 patients (382 shoulders) in 8 studies were included. Patient sample sizes ranged from 8 patients (9 shoulders) to 98 patients (107 shoulders), and the samples were predominantly comprised of male patients (range, 57.1%-100%). The mean age and follow-up period ranged from 38 to 59 years and from 13.7 to 46.8 months, respectively. In studies reporting both preoperative and postoperative outcomes, improvements were found in American Shoulder and Elbow Surgeons scores (range, 8.6-22) and visual analog scale scores for pain (range, 0.4-3.8). There was significant heterogeneity (I2 = 75%) in the rates of conversion to shoulder arthroplasty, which ranged from 4% to 42.4%, with the mean time to conversion ranging from 9 to 56 months. Study heterogeneity improved with subgroup analyses based on minimum duration of follow-up (>2 years) and preoperative radiographic inclusion criteria. CONCLUSIONS: Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. Despite variability in procedures and rates of subsequent conversion to arthroplasty, arthroscopic treatment appears to provide symptom relief and functional improvements in carefully selected patients. However, the longevity of improvement remains unclear, with studies including a longer duration of follow-up showing potential regression of symptom relief and increased rates of conversion to arthroplasty. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/32151663/Outcomes_and_Survivorship_After_Arthroscopic_Treatment_of_Glenohumeral_Arthritis:_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(20)30191-2 DB - PRIME DP - Unbound Medicine ER -
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