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Viêm khớp vai

Shoulder arthritis causes pain, stiffness, and reduced range of motion — diagnosis and treatment options explored.

Updated Jun 2026
Một minh họa vẽ tay của khớp vai cánh tay trên - xương bả vai bị thoái hóa nặng, xương tiếp xúc trực tiếp với nhau.
Viêm khớp vai trên phim X-quang: sụn đệm giữa đầu xương và ổ khớp đã bị mòn hết, khe khớp bị hẹp, và gai xương đã hình thành quanh viền. Kieran Hirpara 4.0

Trang này được dịch bằng máy và chưa được bác sĩ kiểm tra. Bản tiếng Anh là bản chính thức.

Những gì bạn đang cảm thấy

Viêm khớp vai là một tình trạng phổ biến. Nó gây ra tổn thương do hao mòn lên các bề mặt khớp. Bạn có thể nhận thấy rằng tuổi tác tăng lên mang lại nhiều đau đớn và những thay đổi rõ rệt trên phim X-quang. Cơn đau thường bắt đầu một cách từ từ. Trong một số trường hợp, nó trở nên phá hủy nhanh chóng, đặc biệt là ở những phụ nữ lớn tuổi.

Bạn có khả năng sẽ cảm thấy đau sâu trong khớp vai. Cơn đau này thường trở nên tồi tệ hơn vào ban đêm. Nó cũng có thể bùng phát sau khi bạn sử dụng cánh tay hoặc khi bạn vừa thức dậy. Các nhiệm vụ hàng ngày đơn giản trở nên khó khăn. Bạn có thể gặp khó khăn khi với tay ra sau lưng để cài áo ngực. Việc nhét áo vào quần có thể cảm thấy bất tiện hoặc gây đau. Nâng vật dụng lên quá đầu có thể kích hoạt cảm giác khó chịu sắc nhọn.

Bác sĩ phẫu thuật của bạn sẽ kiểm tra các mô hình hao mòn khớp cụ thể. Ví dụ, đầu của xương cánh tay trên của bạn có thể dịch chuyển về phía sau trong hốc khớp. Điều này được gọi là bán dislocation sau. Theo thời gian, sự dịch chuyển này có thể thay đổi cách khớp bị hao mòn. Khoảng 20% các khớp vai có mô hình này phát triển một mô hình hao mòn lệch tâm trong vòng một thập kỷ. Bác sĩ phẫu thuật của bạn tìm kiếm các dấu hiệu này để hiểu rõ tình trạng cụ thể của bạn.

Bạn có thể tự hỏi liệu nhiễm trùng có đang gây ra cơn đau của bạn hay không. Bác sĩ phẫu thuật của bạn có thể sử dụng hình ảnh học tiên tiến, như một loại quét PET/CT đặc biệt, để phân biệt giữa nhiễm trùng và viêm khớp thông thường. Điều này giúp đảm bảo bạn nhận được phương pháp điều trị đúng đắn.

Trong khi các chiến lược quản lý tiếp tục phát triển, đặc biệt là đối với bệnh nhân trẻ tuổi, tuổi thọ của implant vẫn là một mối quan ngại nếu bạn rất năng động. Bác sĩ phẫu thuật của bạn sẽ thảo luận về các lựa chọn tốt nhất dành cho bạn. Thay khớp vai toàn phần giải phẫu thường là lựa chọn tiêu chuẩn nếu các gân rotator cuff của bạn khỏe mạnh. Thay khớp vai toàn phần đảo ngược là một lựa chọn khác, đặc biệt nếu cuff bị tổn thương hoặc trong các trường hợp phức tạp. Cả hai phương pháp đều nhằm mục đích giảm đau và cải thiện chức năng.

Nếu các dấu hiệu viêm khớp của bạn nhẹ trên phim X-quang, bạn có khả năng cao gấp bảy lần không cảm thấy cải thiện đáng kể sau khi thay khớp vai toàn phần giải phẫu so với bệnh nhân bị viêm khớp nặng. Đây là bối cảnh quan trọng cho việc ra quyết định của bạn. Bác sĩ phẫu thuật của bạn sẽ giúp bạn cân nhắc các yếu tố này đối với nhu cầu hàng ngày và mức độ hoạt động của bạn.

Những gì thực sự đang xảy ra

Viêm khớp vai là một tình trạng thoái hóa phổ biến, trong đó lớp phủ trơn tru ở đầu xương bị phá hủy. Lớp phủ này, được gọi là sụn, hoạt động như một bộ giảm xóc. Khi sụn mỏng đi hoặc biến mất, các xương cọ xát vào nhau. Điều này gây ra đau đớn và cứng khớp. Bao khớp của bạn, tức là lớp bao quanh vai, cũng có thể bị co thắt.

Trong nhiều trường hợp, các gân của nhóm cơ xoay cuff vẫn còn nguyên vẹn. Các gân này giống như những sợi dây giúp bạn nâng cánh tay. Khi chúng hoạt động tốt, bác sĩ phẫu thuật có thể thực hiện phẫu thuật thay khớp vai toàn bộ giải phẫu học (anatomic total shoulder replacement). Thủ thuật này thay thế các bề mặt xương bị mòn bằng các bộ phận nhân tạo mô phỏng hình dạng khớp tự nhiên của bạn. Đây là phương pháp điều trị tiêu chuẩn khi cuff khỏe mạnh.

Đôi khi, gân xoay cuff bị rách hoặc yếu. Không có các gân này, đầu xương hình cầu của khớp bị trượt ra khỏi vị trí. Khi đó, bác sĩ phẫu thuật có thể khuyên bạn thực hiện phẫu thuật thay khớp vai toàn bộ đảo ngược (reverse total shoulder replacement). Phẫu thuật này đảo ngược vị trí của đầu xương hình cầu và ổ chảo. Nó sử dụng cơ delta của bạn để nâng cánh tay thay vì các gân bị rách. Thiết kế này giúp bạn phục hồi chuyển động ngay cả khi cuff bị tổn thương.

Cách vai của bạn di chuyển thay đổi sau phẫu thuật. Xương bả vai của bạn, hay còn gọi là xương bả vai, phải làm việc nhiều hơn để di chuyển cánh tay của bạn. Điều này là bình thường và dự kiến. Thiết kế khớp mới cho phép phạm vi chuyển động đầy đủ, mặc dù các mẫu chuyển động khác với vai khỏe mạnh.

Thiết kế implant đã được cải thiện đáng kể. Các khớp nhân tạo hiện đại vừa khít chính xác hơn và di chuyển tự nhiên hơn. Tuy nhiên, tuổi thọ của các implant này vẫn là một mối quan tâm đối với những bệnh nhân năng động. Những người trẻ tuổi hoặc năng động hơn có thể làm mòn các bộ phận nhân tạo nhanh hơn. Bác sĩ phẫu thuật của bạn sẽ chọn lựa chọn tốt nhất dựa trên mức độ tổn thương khớp cụ thể và mức độ hoạt động của bạn.

Những gì chúng tôi có thể làm về vấn đề này

Chúng tôi luôn bắt đầu bằng các phương pháp không phẫu thuật, đặc biệt nếu bệnh viêm xương khớp do hao mòn của bạn ở mức độ trung bình hoặc nhẹ. Bác sĩ phẫu thuật của bạn có thể sẽ khuyên nên thực hiện một liệu trình tự quản lý và vật lý trị liệu trước tiên. Cách tiếp cận này tập trung vào việc duy trì cử động của vai và tăng cường các cơ xung quanh để giảm áp lực lên khớp. Bạn có thể mong đợi sẽ dành đủ thời gian cho phương pháp điều trị bảo tồn này trước khi xem xét các bước xâm lấn hơn. Đây là biện pháp phòng thủ đầu tiên tiêu chuẩn để giúp bạn kiểm soát cơn đau và duy trì chức năng mà không cần phẫu thuật.

Nếu các chuyển động nhẹ nhàng và bài tập không đủ hiệu quả, chúng tôi sẽ xem xét các biện pháp quản lý bằng y học để kiểm soát các triệu chứng của bạn. Điều này thường bao gồm việc sử dụng thuốc giảm đau và thuốc chống viêm để giảm sưng và khó chịu. Bác sĩ phẫu thuật của bạn cũng có thể thảo luận về các loại tiêm. Tiêm cortisone có thể giảm đau đáng kể trong một khoảng thời gian giới hạn, giúp bạn quay trở lại các hoạt động hàng ngày. Các lựa chọn khác như tiêm axit hyaluronic hoặc huyết tương giàu tiểu cầu (PRP) đôi khi được sử dụng để bôi trơn khớp hoặc thúc đẩy quá trình chữa lành, mặc dù thời gian tác dụng của chúng khác nhau. Những phương pháp điều trị này không chữa khỏi bệnh viêm xương khớp, nhưng chúng có thể giúp bạn có thêm thời gian và cải thiện chất lượng cuộc sống trong khi bạn quản lý tình trạng này.

Phẫu thuật chỉ được xem xét khi các phương pháp điều trị bảo tồn đã đạt đến giới hạn và cơn đau của bạn vẫn còn nghiêm trọng. Ở giai đoạn này, bác sĩ phẫu thuật của bạn có thể khuyên nên thay khớp vai, còn được gọi là phẫu thuật tạo hình khớp (arthroplasty). Thủ thuật này thay thế các phần bị tổn thương của khớp bằng các bộ phận nhân tạo để khôi phục chuyển động trơn tru và giảm đau. Loại thay thế cụ thể phụ thuộc vào tình trạng của nhóm cơ xoay vai (rotator cuff) và mức độ tổn thương xương. Ví dụ, thay khớp vai toàn phần giải phẫu là tiêu chuẩn nếu nhóm cơ xoay vai của bạn còn nguyên vẹn, trong khi thay khớp vai toàn phần ngược thường được sử dụng cho các trường hợp phức tạp hơn liên quan đến tổn thương nhóm cơ xoay vai. Những phương pháp điều trị phẫu thuật này được coi là hiệu quả đối với các trường hợp nghiêm trọng và có thể mang lại những cải thiện đáng kể, bền vững trong khả năng sử dụng cánh tay của bạn.

Những điều cần mong đợi

Viêm khớp vai là một tình trạng phổ biến gây ra sự mòn và hao mòn của các bề mặt khớp. Nếu không được điều trị, các triệu chứng thường dai dẳng và có thể trở nên trầm trọng hơn theo thời gian. Nhiều bệnh nhân trải qua tình trạng đau đớn và cứng khớp kéo dài, hạn chế các hoạt động hàng ngày. Nếu bạn có các dấu hiệu viêm khớp nhẹ trên hình ảnh chẩn đoán, bạn có khả năng cao hơn gấp bảy lần so với những người bị viêm khớp nặng trong việc cảm thấy rằng phẫu thuật không mang lại đủ hiệu quả. Điều này nhấn mạnh lý do tại sao bác sĩ phẫu thuật của bạn cân nhắc kỹ lưỡng việc lựa chọn phương pháp điều trị phù hợp với giai đoạn bệnh của bạn.

Khi được quản lý tốt, các lựa chọn phẫu thuật như thay khớp có thể mang lại sự giảm đau đáng kể. Hầu hết bệnh nhân thấy cải thiện đáng kể về mức độ đau và chức năng vận động. Đối với những người có gân rotator cuff nguyên vẹn, cả hai phương pháp thay khớp giải phẫu (anatomic) và thay khớp ngược (reverse) đều mang lại kết quả tốt. Đặc biệt, thay khớp ngược cho thấy tỷ lệ biến chứng thấp trong ngắn hạn đối với nhóm bệnh nhân này. Ngay cả khi bác sĩ phẫu thuật của bạn cần chuyển sang thay khớp ngược trong quá trình phẫu thuật, kết quả của bạn có khả năng tương đương với những người đã lên kế hoạch cho phương pháp này ngay từ đầu.

Tiên lượng dài hạn khác nhau. Trong khi nhiều người tận hưởng sự cải thiện bền vững, tuổi thọ của khớp nhân tạo vẫn là một mối quan tâm, đặc biệt nếu bạn năng động. Một số bệnh nhân tiếp tục bị đau hoặc trải qua tình trạng xói mòn xương hơn 10 năm sau một số loại thay khớp. Ngoài ra, khoảng 16% bệnh nhân phát triển viêm khớp ở khớp ức đòn (nằm ở phần nhô lên trên cùng của vai) trong vòng 12 năm sau khi thay khớp giải phẫu. Sức mạnh ở phần trước của vai có thể không trở lại bình thường hoàn toàn trong hai năm, mặc dù bạn sẽ có khả năng thấy sự cải thiện so với mức độ ban đầu.

Quá trình hồi phục là một tiến trình, không phải là một sự kiện đơn lẻ. Bạn nên mong đợi sự tiến triển dần dần trong vài tuần và vài tháng. Trong khi cơn đau thường giảm đi, sức mạnh hoàn toàn cần thời gian để xây dựng lại. Bác sĩ phẫu thuật của bạn sẽ hướng dẫn bạn trong quá trình này, nhưng việc hiểu rằng một số hạn chế hoặc khó chịu có thể kéo dài giúp thiết lập những kỳ vọng thực tế. Mục tiêu là khôi phục chức năng và giảm đau, cho phép bạn trở lại với các hoạt động quan trọng nhất đối với bạn.

Khi nào cần gặp bác sĩ

Viêm khớp vai phổ biến và thường trở nên nghiêm trọng hơn theo tuổi tác. Hãy gặp bác sĩ đa khoa nếu bạn có cơn đau dai dẳng không thuyên giảm khi nghỉ ngơi. Hãy tìm kiếm sự đánh giá của bác sĩ chuyên khoa nếu bạn cảm thấy yếu, mất ổn định, hoặc nếu vai của bạn bị khóa hoặc đột ngột mất sức. Những triệu chứng này có thể cản trở giấc ngủ hoặc công việc. Sự gia tăng đột ngột của cơn đau cần được chú ý. Điều này đặc biệt đúng đối với phụ nữ lớn tuổi có cơn đau vai âm ỉ, điều này có thể cho thấy bệnh viêm khớp phá hủy nhanh chóng. Bác sĩ phẫu thuật của bạn có thể sử dụng hình ảnh học để phân biệt giữa nhiễm trùng và viêm khớp do hao mòn. Đánh giá sớm giúp kiểm soát các triệu chứng và lập kế hoạch điều trị, bao gồm cả việc thay thế khớp tiềm năng.


Evidence & references

Overview

  • Standardization of outcome assessment following treatment of shoulder arthritis is needed [1].
  • Shoulder arthritis is common [2].
  • Management strategies for shoulder arthritis, especially in young patients, continue to evolve [2].
  • Significant improvements in implant design have occurred for shoulder arthritis management [2].
  • Implant longevity remains a concern in more active patients with shoulder arthritis [2].
  • Anatomic total shoulder arthroplasty (ATSA) is the benchmark for surgical treatment of glenohumeral arthritis with an intact cuff [19].
  • Reverse total shoulder arthroplasty (RTSA) has gained popularity for rotator cuff arthropathy and other complex indications [19].
  • Knowledge of the array of shoulder prostheses currently available and their indications can lead to optimized patient outcomes [11].
  • Use of treatment algorithms can lead to optimized patient outcomes in shoulder arthroplasty [11].
  • Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of patient-reported pain, function, or adverse effects [24].
  • The evidence comparing total shoulder arthroplasty to hemiarthroplasty is of low quality [24].
  • Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty [3].
  • Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].
  • Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
  • The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [7].
  • A clear standardized set of shoulder arthroplasty complication definitions is lacking [8].
  • Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis [26].

Anatomy & Pathophysiology

  • Pathoanatomic metrics with identified threshold values can discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
  • Measurement of humeral subluxation in the glenoid hull plane may be more accurate than measurement in the scapular plane [27].
  • Scapular kinematics in patients with shoulder arthroplasty are influenced by the implementation of external loads, but not by the type of load [34].
  • Scaption kinematics in reverse shoulder arthroplasty do not change after the sixth postoperative month [35].
  • Elliptical and spherical humeral heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty [37].
  • Geometric analysis of the prosthetic shoulder is precise [38].
  • Reverse total shoulder arthroplasty (RTSA) shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but exhibit much greater intersubject variation and larger moment-arm magnitudes [41].
  • In RTSA, although the teres minor external rotation moment arm is higher than in a normal shoulder, decreased length could impair force generation [42].
  • Reverse total shoulder arthroplasty alters humerothoracic, scapulothoracic, and glenohumeral motion during weighted scaption [43].
  • Custom, non-spherical prosthetic heads more accurately replicate head shape, rotational range of motion, and glenohumeral joint kinematics compared with commercially available spherical prosthetic heads when compared to the native humeral head [44].
  • The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with reverse total shoulder arthroplasty compared with a healthy shoulder [47].
  • Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss [51].
  • Anatomic total shoulder arthroplasty results in tendon-metal contact and higher tendon contact pressures compared to the native shoulder [52].
  • The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction [55].
  • Glenosphere configuration can be modified to increase range of movement in reverse shoulder arthroplasty [56].

Classification

  • Pathoanatomic metrics with identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
  • Anatomic patterns of glenoid bone loss exist for different classes of glenohumeral arthritis [14].
  • Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed over a decade [18].
  • Concentric arthritis developed an eccentric pattern 20% of the time over a decade [18].
  • Measurement of humeral subluxation in the glenoid hull plane may be more accurate than in the scapular plane [27].
  • A 3-dimensional classification system using combined humeroscapular alignment and glenoid erosion can be applied to describe degenerative glenohumeral arthritis comprehensively [36].
  • A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology [40].
  • Osteoarthritic humeral head morphology varies significantly from normal, characterized by larger spherical diameters [58].
  • Osteoarthritic humeral head morphology does not vary as a function of the Walch classification between symmetric and asymmetric glenoids [58].

Clinical Presentation

  • Shoulder arthritis is a common condition [2].
  • Management strategies for shoulder arthritis, particularly in young patients, continue to evolve with significant improvements in implant design, although longevity remains a concern in more active patients [2].
  • Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
  • Pathoanatomic metrics with identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
  • Rapidly destructive arthrosis of the shoulder joints should be considered in the differential diagnosis of elderly women with insidious shoulder pain [10].
  • Increased age is the main determinant of radiological changes in shoulder osteoarthritis, as well as pain [12].
  • Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed, while concentric arthritis developed an eccentric pattern 20% of the time over a decade [18].
  • Arthritic B2 glenoids are common, and their maximal erosion is usually posteroinferior [48].
  • F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis [22].

Investigations

  • Standardization of outcome assessment is needed following treatment of shoulder arthritis [1].
  • Pathoanatomic metrics with identified threshold values can discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
  • Rapidly destructive arthrosis should be considered in the differential diagnosis of elderly women with insidious shoulder pain [10].
  • Increased age is the main determinant of radiological changes in shoulder osteoarthritis [12].
  • Increased age is the main determinant of pain in shoulder osteoarthritis [12].
  • Anatomic patterns of glenoid bone loss exist for different classes of glenohumeral arthritis [14].
  • F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis [22].
  • In healthy/nonosteoarthritic shoulders, increased glenoid retroversion is associated with decreased anterior glenoid offset [31].
  • Additional research is required to document the clinical value of new technologies to patients with glenohumeral arthritis [32].
  • MRI offers a more precise method of determining glenoid version compared with x-ray imaging for preoperative osseous imaging in total shoulder arthroplasty [57].
  • The critical shoulder angle is an effective radiographic parameter associated with rotator cuff tears and osteoarthritis [63].
  • Three-dimensional CT reconstruction allows for reliable evaluation of the scapulohumeral relationship [64].
  • Three-dimensional CT reconstruction reveals significant posterior translation of the humeral head in osteoarthritic shoulders compared to nonpathologic controls [64].
  • Significant posterior translation of the humeral head in osteoarthritic shoulders supports the pathomechanism of glenoid component loosening [64].
  • A quantitative method for determining medial migration of the humeral head on plain radiographs is inexpensive, practical, and reproducible after shoulder arthroplasty [67].
  • Cystic disease in the glenoid did not affect functional outcome after total shoulder arthroplasty with minimum 5-year follow-up [68].
  • Cystic disease in the glenoid did not affect the presence of radiographic glenoid loosening after total shoulder arthroplasty with minimum 5-year follow-up [68].
  • Three significantly differently oriented posterior erosion patterns (posterior-superior, posterior-central, and posterior-inferior) were distinguished in shoulders demonstrating posterior wear on axillary imaging [69].

Treatment

Non-Operative Management

  • Nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild shoulder osteoarthritis [17].

Surgical Management: General Principles and Indications

  • Anatomic total shoulder arthroplasty (ATSA) is the benchmark for surgical treatment of glenohumeral arthritis with an intact rotator cuff [19].
  • Reverse total shoulder arthroplasty (RTSA) has gained popularity for rotator cuff arthropathy and other complex indications [19].
  • Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [17].
  • Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes [11].
  • Shoulder arthritis is common, and management strategies, especially in young patients, continue to evolve with significant improvements in implant design [2].
  • Longevity of implants remains a concern in more active patients with shoulder arthritis [2].

Surgical Management: Anatomic Total Shoulder Arthroplasty (ATSA)

  • Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
  • Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis [26].
  • There was no clinically or statistically significant difference in the Oxford Shoulder Score results between groups with and without glenoid cementation in total shoulder arthroplasty for degenerative arthritis of the shoulder [28].
  • Total shoulder arthroplasty (TSA) is superior to hemiarthroplasty for treating end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old, resulting in greater cost savings, fewer revision procedures, and greater quality-adjusted life years (QALYs) gained [65].

Surgical Management: Reverse Total Shoulder Arthroplasty (RTSA)

  • Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty [3].
  • Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].

Surgical Management: Surface Replacement Arthroplasty

  • Cemented surface replacement arthroplasty (CSRA) provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients [9].
  • Patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected [50].

Surgical Management: Arthroscopic and Other Procedures

  • The authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis known as the Comprehensive Arthroscopic Management (CAM) procedure [16].
  • Scapulothoracic fusion resulted in improvements in functional outcomes scores, with most patients meeting or exceeding the minimum clinically important difference for recalcitrant scapular winging [53].

Outcome Assessment and Registry Data

  • The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [7].
  • The PROMIS Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after total shoulder arthroplasty [33].
  • A study of 1,270 individual patients from eleven centers demonstrated significant improvement in patient-reported outcomes at 1 and 2 years post-surgery for a polyethylene glenoid with a fluted peg, establishing a benchmark for early clinical value [54].

Standardization and Complications

  • There is a need for standardization of outcome assessment following treatment of shoulder arthritis [1].
  • A clear standardized set of shoulder arthroplasty complication definitions is lacking [8].

Complications

  • Standardized definitions for shoulder arthroplasty complications are lacking [8].
  • Standardization of outcome assessment following treatment of shoulder arthritis is needed [1].
  • Longevity of implants remains a concern in more active patients with shoulder arthritis [2].
  • Total shoulder arthroplasty is associated with high mid-term complication rates due to instability and loosening in B2 glenoids [45].
  • Symptomatic acromioclavicular joint osteoarthritis occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years [15].
  • No case of glenoid loosening occurred at 3 years' follow-up in revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders [21].
  • Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of adverse effects, although the evidence was of low quality [24].

Recovery

  • Standardization of outcome assessment is needed following treatment of shoulder arthritis [1].
  • Implant longevity remains a concern in more active patients with shoulder arthritis [2].
  • Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty (TSA) [3].
  • Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].
  • Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [23].
  • Surgeons may consider using reverse arthroplasty in cases of primary shoulder arthritis with a critical shoulder angle of 35 degrees or greater [29].
  • The PROMIS Global-10 has limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA [33].
  • Subscapularis strength returned to normal in only a minority of patients at 2 years after shoulder arthroplasty, although significant strength improvement from baseline was observed [60].
  • There is a substantive subgroup with continuing pain and a high rate of glenoid bone erosion after 10 years following humeral head replacement for osteoarthritis [70].

Key Evidence

  • [L1] The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. (10.1177/1758573215622385)
  • [L5] Shoulder arthritis is common, and management strategies, especially in young patients, continue to evolve with significant improvements in implant design, though longevity remains a concern in more active patients. (10.1016/j.csm.2018.07.001)
  • [L3] Patients with glenohumeral osteoarthritis converted intraoperatively to RSA had outcomes comparable to those who underwent total shoulder arthroplasty. (10.1016/j.jse.2015.01.005)
  • [L4] Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff. (10.1016/j.jse.2021.06.010)
  • [Paper] Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis. (10.1097/corr.0000000000002747)
  • [L4] Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis. (10.1016/j.jse.2021.03.140)
  • [L4] The authors recommend the continued use of WOOS in shoulder arthroplasty registries and observational studies. (10.1186/s12891-023-06578-5)
  • [L1] A clear standardised set of shoulder arthroplasty complication definitions is lacking. (10.1007/s00402-017-2635-9)
  • [L4] CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. (10.1016/j.jse.2014.11.035)
  • [L4] This condition should be considered in the differential diagnosis of elderly women with insidious shoulder pain. (10.1016/j.jse.2014.10.020)
  • [L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. (10.5435/00124635-200907000-00002)
  • [L3] This study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. (10.1186/s13018-022-03137-x)
  • [L4] These data demonstrate an anatomic pattern of glenoid bone loss for different classes of glenohumeral arthritis. (10.1007/s12306-016-0406-3)
  • [L4] Symptomatic ACJ OA occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years. (10.1177/17585732221114796)
  • [L4] The authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. (10.1016/j.arthro.2022.01.033)
  • [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. (10.1155/2013/370231)
  • [L4] Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed, while concentric arthritis developed an eccentric pattern 20% of the time. (10.1016/j.jse.2020.05.021)
  • [L4] At 3 years' follow-up, pain and clinical scores improved significantly and no case of glenoid loosening occurred. (10.1016/j.jse.2013.05.004)
  • [L3] F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis. (10.1016/j.jse.2025.01.047)
  • [L3] At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. (10.5435/jaaos-d-22-00014)
  • [L1] Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of patient-reported pain, function, nor adverse effects; however, the evidence on this topic was of low quality. (10.1097/corr.0000000000001523)
  • [L3] Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis. (10.1016/j.jse.2021.12.016)
  • [L4] Measurement in the glenoid hull plane may be more accurate than in the scapular plane. (10.1016/j.jse.2017.01.027)
  • [L3] There was no clinically or statistically significant difference in the Oxford Shoulder Score results between the two groups. (10.1016/j.jse.2013.08.022)
  • [L3] These data suggest that surgeons may consider using reverse arthroplasty in cases of primary shoulder arthritis with a critical shoulder angle of 35 degrees or greater. (10.1016/j.jse.2021.08.003)
  • [L4] In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset. (10.1016/j.jse.2023.09.031)
  • [L4] Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. (10.2106/jbjs.20.01853)
  • [L3] The Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA. (10.1016/j.jse.2020.10.021)
  • [L4] Scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. (10.1016/j.clinbiomech.2012.04.009)
  • [L4] Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month. (10.1016/j.clinbiomech.2018.07.005)
  • [L3] The 3D classification system using combined humeroscapular alignment and glenoid erosion can be applied to describe the disease comprehensively. (10.1177/23259671221110512)
  • [L5] A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. (10.1186/s12891-023-06273-5)
  • [L2] Geometric analysis of the prosthetic shoulder is precise. (10.1007/s00402-012-1580-x)
  • [L3] A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology. (10.1016/j.jse.2021.01.018)
  • [L5] RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. (10.1016/j.jse.2015.09.015)
  • [L5] Even if TM external rotation moment arm is higher in RTSA than in a normal shoulder, the decreased length could impair its force generation. (10.1016/j.jse.2014.08.019)
  • [L5] This commentary highlights that reverse total shoulder arthroplasty alters humerothoracic, scapulothoracic, and glenohumeral motion during weighted scaption, emphasizing the need to integrate biomechanical studies, computer modeling, and dynamic clinical evaluations to develop a roadmap for precision rTSA. (10.1097/corr.0000000000002383)
  • [L5] The custom, non-spherical prosthetic head more accurately replicated the head shape, rotational range of motion, and glenohumeral joint kinematics than the commercially available, spherical prosthetic head compared with the native humeral head. (10.1016/j.jse.2013.01.002)
  • [L5] Total shoulder arthroplasty may have reasonable short-term results but is associated with high mid-term complication rates due to instability and loosening in B2 glenoids. (10.1016/j.jse.2013.06.017)
  • [L4] The ST contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder. (10.1016/j.jse.2024.12.018)
  • [L4] Arthritic B2 glenoids are common, and their maximal erosion is usually posteroinferior. (10.1016/j.jse.2015.01.007)
  • [L4] Patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected. (10.1007/s11999-007-0104-4)
  • [L5] Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. (10.1177/0363546518768276)
  • [L5] Anatomic total shoulder arthroplasty results in tendon-metal contact and higher tendon contact pressures compared to the native shoulder. (10.1016/j.jse.2018.04.017)
  • [L4] Scapulothoracic fusion resulted in improvements in functional outcomes scores, with most patients meeting or exceeding the minimum clinically important difference. (10.1097/corr.0000000000002673)
  • [L4] The study establishes a benchmark for early clinical value of new glenoid components by demonstrating significant improvement in patient-reported outcomes at 1 and 2 years post-surgery across a large multicenter cohort. (10.1007/s00264-018-4213-3)
  • [L4] The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. (10.1016/j.jse.2022.10.009)
  • [L5] Glenosphere configuration can be modified to increase range of movement in reverse shoulder arthroplasty. (10.1302/0301-620x.100b9.bjj-2018-0264.r1)
  • [L3] MRI is useful for preoperative osseous imaging for total shoulder arthroplasty because it offers a more precise method of determining glenoid version compared with x-ray imaging. (10.1016/j.jse.2012.10.036)
  • [L4] Osteoarthritic humeral head morphology varies significantly from normal, with larger spherical diameters, but does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. (10.1016/j.jse.2015.08.047)
  • [L4] Although significant strength improvement from baseline was observed at 2 years after shoulder arthroplasty, subscapularis strength returned to normal in only a minority of patients. (10.1016/j.jse.2014.06.042)
  • [L4] The CSA is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis. (10.1136/jisakos-2018-000255)
  • [L4] The study demonstrates that 3D CT reconstruction allows for reliable evaluation of the scapulohumeral relationship, revealing significant posterior translation of the humeral head in osteoarthritic shoulders compared to nonpathologic controls, which supports the pathomechanism of glenoid component loosening. (10.1016/j.jse.2016.02.035)
  • [L2] Treatment of end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old in the United States with TSA, instead of hemiarthroplasty, would result in greater cost savings, avoid a substantial number of revision procedures, and result in greater years of satisfactory or excellent patient outcomes and greater QALYs gained. (10.1007/s11999-016-4991-0)
  • [L3] This is an inexpensive, practical, and reproducible method that can be used to determine the rate of medial migration of the humeral head on plain radiographs after shoulder arthroplasty. (10.1016/j.jse.2010.03.010)
  • [L3] Cystic disease did not affect functional outcome or the presence of radiographic glenoid loosening. (10.1016/j.jse.2017.10.035)
  • [L4] Three significantly differently oriented wear patterns (posterior-superior, posterior-central, and posterior-inferior) were distinguished in shoulders demonstrating posterior wear on axillary imaging. (10.1016/j.jse.2021.04.028)
  • [L4] However, there is a substantive subgroup with continuing pain and a high rate of glenoid bone erosion after 10 years. (10.1016/j.jse.2017.10.017)

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