These authors reported their outcomes and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of glenohumeral osteoarthritis at a minimum of 5 years postoperatively in 46 patients (49 shoulders).
The CAM procedure included glenohumeral chondroplasty, capsular release, synovectomy, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture, and biceps tenodesis.
Two patients were excluded for refusing to participate before study initiation.
The mean age at surgery was 52 years (range, 27-68 years) in 15 women and 29 men.
Twelve shoulders (26%) progressed to total shoulder arthroplasty at a mean of 2.6 years (range, 0.5-8.2 years). For 45 of 47 (96%) shoulders, survivorship was 95.6% at 1 year, 86.7% at 3 years, and 76.9% at 5 years.
2 additional patients required secondary arthroscopic surgery; one underwent capsular release for stiffness at 5.6 months, and another underwent a revision CAM procedure at 7.9 years.
Factors associated with failure and progression to TSA were a Walch type B2 or C glenoid shape and preoperative joint space narrowing defined as less than 2 mm of joint space remaining as seen on a Grashey or true anterior-posterior radiograph of the glenohumeral joint.
Subjective outcome data were available for 28 shoulders at a mean of 5.7 years.
Subjective outcome data were available for 28 shoulders at a mean of 5.7 years.
Comment:
As indicated by Table 2 of this paper, there is wide variability in what is actually done in this procedure, making it difficult to discern what elements contribute to the outcome. For example, is there evidence that an axillary nerve release is indicated in 1/3 of shoulders with arthritis? Do patients with osteoarthritis have synovitis requiring synovectomy?
Five year followup was available only on 53% (28/49) of the cases.
It appears that the outcomes were better if the arthritis was milder (2 mm or more of preserved joint space, less severe Walch glenoid types).
It would be of interest to know whether the 26% of the patients who required subsequent total shoulder arthroplasty realized the same quality results as patients having primary arthroplasty.
Further comparative studies will be needed to determine the place of this procedure among the other options in the management of arthritis for patients with a mean age of 52.
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