Management of Glenohumeral Joint Osteoarthritis

Publication Date: March 23, 2020
Last Updated: July 29, 2022

RECOMMENDATIONS

HYALURONIC ACID

Strong evidence supports that there is no benefit to the use of hyaluronic acid in the treatment of glenohumeral joint osteoarthritis. (S)
312070

PROGNOSTIC FACTORS (BMI: BODY MASS INDEX)

Strong evidence suggests that obese patients with glenohumeral osteoarthritis do not experience an increase in the rate of early post-operative complications. (S)
312070

PROGNOSTIC FACTORS (GENDER/SEX)

Strong evidence supports that gender/sex is not associated with better or worse post-operative outcomes. (S)
312070

PROGNOSTIC FACTORS (COMORBIDITIES)

Strong evidence suggests that patients with glenohumeral joint osteoarthritis who have more comorbidities experience higher rates of early post-arthroplasty complications. (S)
312070

TOTAL SHOULDER ARTHROPLASTY

Strong evidence supports that anatomic total shoulder arthroplasty demonstrates more favorable function and pain relief in the short- to mid-term follow-up when compared to hemiarthroplasty for the treatment of glenohumeral osteoarthritis. (S)
312070

GLENOID COMPONENTS – PEGGED OR KEELED

Strong evidence supports that the clinician may utilize pegged or keeled glenoid components in patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff. Pegged components demonstrate less radiolucent lines, but the effect on clinical outcomes and survivorship are unclear. (S)
312070

PROGNOSTIC FACTORS (AGE)

Moderate evidence supports that older age at the time of surgery is associated with lower revision rates. (M)
312070

PROGNOSTIC FACTORS (SMOKING)

Moderate evidence suggests that smoking is associated with inferior post-operative outcomes. (M)
312070

PROGNOSTIC FACTORS (PRE-OPERATIVE FUNCTION)

Moderate quality evidence suggests that, while both higher and lower pre-operative functioning patients with glenohumeral joint osteoarthritis will likely experience improvement following arthroplasty, patients with higher pre-operative function may experience less functional improvement. (M)
312070

PROGNOSTIC FACTORS (DEPRESSION)

Moderate evidence suggests that depression is associated with inferior post-operative outcomes in patients with glenohumeral joint osteoarthritis undergoing arthroplasty. (M)
312070

GLENOID COMPONENTS – METAL-BACKED CEMENTLESS

Moderate evidence supports that surgeons not use metal-backed cementless glenoid components. (M)
312070

TOTAL SHOULDER ARTHOPLASTY -- SUBSCAPULARIS PEEL, TENOTOMY, LESSER TUBEROSITY OSTEOTOMY

Moderate evidence supports that surgeons can utilize subscapularis peel, lesser tuberosity osteotomy, or tenotomy when performing shoulder arthroplasty. (M)
312070

HEMIARTHROPLASTY – STEMS

Limited evidence supports that clinicians may utilize stemmed, stemless or resurfacing prosthesis for patients with glenohumeral joint osteoarthritis undergoing total or hemi-arthroplasty. (L)
312070

CONSENSUS STATEMENTS

PRE-OPERATIVE PHYSICAL THERAPY

In the absence of reliable evidence, it is the opinion of the work group that physical therapy may benefit select patients with glenohumeral joint osteoarthritis. (C)
312070

POST-OPERATIVE PHYSICAL THERAPY

In the absence of reliable evidence, it is the opinion of the work group that clinicians may prescribe physical therapy in patients following shoulder arthroplasty. (C)
312070

INJECTABLE BIOLOGICS

In the absence of reliable evidence, it is the opinion of the work group that injectable biologics, such as stem cells or platelet-rich plasma, cannot be recommended in the treatment of glenohumeral osteoarthritis. (C)
312070
ALTERNATIVE NON-SURGICAL TREATMENTS In the absence of reliable evidence, the work group cannot recommend for or against the use of the following:
  • Acupuncture
  • Dry needling
  • Cannabis
  • Cannabodiol (CBD) oil
  • Capsaicin
  • Shark cartilage
  • Glucosamine and chondroitin
  • Cupping
  • Transcutaneous Electrical Nerve Stimulation (TENS)
(C)
312070

OPIOID PAIN MEDICATION

In the absence of reliable evidence, it is the opinion of the work group that opioids not be prescribed as routine and long-term pain management of glenohumeral osteoarthritis. (C)
312070

NON-PROSTHETIC SURGICAL OPTIONS

In the absence of reliable evidence, it is the opinion of the work group that non-prosthetic surgical options may or may not provide short-term benefit for patients with glenohumeral joint osteoarthritis. (C)
312070

RADIOGRAPHS

In the absence of reliable evidence, it is the opinion of the work group that patients with glenohumeral osteoarthritis undergoing arthroplasty should be imaged with axillary and true AP (Grashey view) radiographs, with advanced imaging performed at the discretion of the clinician. (C)
312070

CEMENTED STEMS

In the absence of reliable evidence, it is the opinion of the work group that either cemented or cementless stems can be utilized in the treatment of patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff. (C)
312070

ANATOMIC/ REVERSE TOTAL SHOULDER ARTHROPLASTY

In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use either anatomic total shoulder arthroplasty (TSA) or reverse TSA for the treatment of glenohumeral joint osteoarthritis in select patients with excessive glenoid bone loss and/or rotator cuff dysfunction. (C)
312070

GLENOID COMPONENTS – POLYETHYLENE-METAL OR ALL-POLYETHYLENE

In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use polyethylene-metal hybrid glenoid components or all-polyethylene components during total shoulder arthroplasty for treatment of glenohumeral joint osteoarthritis. (C)
312070

BICEPS TENODESIS AND TENOTOMY

In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may consider concomitant biceps tenodesis or tenotomy during shoulder arthroplasty. (C)
312070

TRANEXEMIC ACID

In the absence of reliable evidence, it is the opinion of the workgroup that utilization of tranexamic acid during shoulder arthroplasty may result in reduced blood loss and reduced risk of blood transfusion. (C)
312070

SUPRASPINATUS TEARS

In the absence of reliable evidence, it is the opinion of the workgroup that, for patients with small isolated, repairable supraspinatus tears, clinicians can perform anatomic total shoulder arthroplasty. (C)
312070

DISCHARGE

In the absence of reliable evidence, it is the opinion of the workgroup that same-day discharge is an option after shoulder arthroplasty in select patients. (C)
312070

CRYOTHERAPY

In the absence of reliable evidence, it is the opinion of the workgroup that either continuous cryotherapy or cold packs can be used following shoulder arthroplasty. (C)
312070

MULTIMODAL PAIN MANAGEMENT

In the absence of reliable evidence, it is the opinion of the workgroup that multimodal pain management strategies or non-opioid individual modalities can provide added benefit for postoperative pain management following shoulder arthroplasty. (C)
312070

Recommendation Grading

Abbreviations

  • AAOS: American Academy Of Orthopedic Surgeons
  • CBD: Cannabodiol
  • OA: Osteoarthritis
  • TENS: Transcutaneous Electrical Nerve Stimulation

Overview

Title

Management of Glenohumeral Joint Osteoarthritis

Authoring Organization

American Academy of Orthopaedic Surgeons

Publication Month/Year

March 23, 2020

Last Updated Month/Year

August 29, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient, Radiology services, School

Intended Users

Nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Rehabilitation

Keywords

gleno-humeral joint, elbow arthritis

Source Citation

American Academy of Orthopaedic Surgeons. Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline. www.aaos.org/gjocpg. Published March 23, 2020.