Comprehensive arthroscopic management versus total shoulder arthroplasty and hemiarthroplasty in patients with primary glenohumeral arthritis younger than 50 years old

Glenohumeral osteoarthritis (OA) is a disabling disease that leads to poor shoulder function and pain. Primary or idiopathic osteoarthritis occurs in previously intact joints without any inciting agent. Its precise incidence is not known. If conservative treatment fails, there are a variety of surgical procedures described in the literature. Total shoulder arthroplasty (TSA) is primarily indicated in patients above 60 years old with symptomatic glenohumeral OA and intact rotator cuff and failed conservative treatment. However, it is rarely recommended to young or active patients under the age of 50 due to its increased morbidity, limited lifespan, potential for revision surgeries, and difficulty achieving the same preoperative activity level, particularly in patients with high preoperative level of activity. Comprehensive arthroscopic management (CAM), hemiarthroplasty (HA), and TSA provide good results even in the long term for treatment of primary OA in properly selected young patients. A CAM procedure seems to be a reasonable option in case of conservative treatment failure, localized cartilage defect, tendinopathy of the long head of the biceps, stiffness, inferior osteophytes, and humeral head congruity. However, in case of humeral head incongruity, large anterior osteophytes, and an intact rotator cuff, an HA or a TSA is a feasible option.