Total shoulder arthroplasty (TSA) should not be performed in patients with glenohumeral osteoarthritis (GHOA) who have an irreparable rotator cuff tear, and physicians should use perioperative mechanical or chemical venous thromboembolism prophylaxis for patients who have undergone shoulder arthroplasty. These were consensus recommendations in The Treatment of Glenohumeral Joint Arthritis, an evidence-based clinical practice guideline recently released by the American Academy of Orthopaedic Surgeons (AAOS) and the first to address GHOA. Another of the 16 recommendations, one favoring TSA over hemiarthroplasty when treating patients with GHOA, was based on moderate-strength evidence.
The final treatment guidelines for patients included both operative and nonoperative options. Key recommendations included the following:
•Injectable viscosupplementation is an option for the treatment of patients with GHOA. An industry-supported study demonstrated that viscosupplementation shows a statistically significant benefit in patients’ pain relief, range of motion, and quality of life. Although the FDA approved the use of viscosupplementation for treatment in knees in 1997, the procedure has not been approved for use in shoulders, it was noted.
•Surgeons should routinely take preventive steps to reduce the risk of potentially catastrophic complications caused by blood clots during and immediately after surgery. Exercises to increase blood flow and blood-thinning medications also can help prevent blood clots.
The AAOS work group found a lack of quality prospective literature for recommending for or against treatment of patients who have GHOA with drug therapy, injectable corticosteroids, or arthroscopy for managing shoulder osteoarthritis (OA) or for treatment after shoulder replacement. It was suggested that patients avoid shoulder replacement by surgeons who perform fewer than 2 shoulder replacements a year to reduce the risk of immediate postoperative complications.
To see the full guideline, visit the AAOS Web site at http://www.aaos.org. Or, contact the organization at American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262; telephone: (847) 823-7186; fax: (847) 823-8125.
