Shoulder arthritis in the young adult population represents a common management dilemma. The widespread interest in sports involving the shoulder (golf, weightlifting, throwing sports) brings relatively young patients with shoulder arthritis to seek pain relief and long-lasting improved function.
Often, shoulder arthroplasty truly is the only reliable option for these patients. However, fear of implant loosening and the possible need for surgical revision has traditionally led to the avoidance of replacement in patients under 65 years old. As a high-volume center with expertise in the most recent advances of shoulder replacement surgery, Mayo Clinic Department of Orthopedic Surgery has shoulder specialists who have both the experience and outcome data to suggest otherwise.
Preserving bone, improving technique
This postoperative photo shows the patient has recovered excellent range of motion and is easily able to extend arms overhead free of pain.
Results from Mayo Clinic's orthopedic shoulder specialty team, led by Joaquin Sanchez-Sotelo, M.D., Ph.D., and John W. Sperling, M.D., indicate that carefully selected younger shoulder arthritis patients may, in fact, benefit from total shoulder arthroplasty.
This is especially true when there is adequate glenoid bone stock and healthy soft tissue, such as a functioning rotator cuff, to help prevent malalignment of the glenoid component implant or imbalance or both. "We've been actively involved in the design of new implants and in their rigorous evaluation, and found that a well-done total shoulder arthroplasty in carefully selected younger patients is typically successful — and often preferable in the long term — to a hemiarthroplasty or partial replacement procedure," explains Dr. Sperling.
Adds Dr. Sanchez-Sotelo: "Our experience is different at Mayo Clinic, principally because we have such broad and deep experience in performing all forms of shoulder arthroplasty, and in conducting research on the topic. We have had a long-standing interest in meeting the needs of the younger shoulder patient, and we have made it a priority to innovate in the area of total shoulder arthroplasty for this patient population by selecting the least bone-invasive implant possible, saving bone for possible future revision surgery if needed."
Evolving design and materials
Improved materials, such as this bone-preserving ultrashort humeral component, contribute to the success of shoulder arthroplasty in young adults
Postoperative total shoulder arthroplasty radiograph shows implant with an ultrashort stem and a modern hybrid glenoid component.
This photograph shows a modern bone-preserving glenoid component, which, when placed by an experienced, advanced surgical team, helps improve shoulder arthroplasty outcomes because of its bone-preserving attributes.
Minimal bone is needed for implantation of new glenoid components, which is a significant advance that can help improve outcomes.
The Mayo team offers the full range of evolving modern implant designs, individualized to each case. Options include high-performance, bone-preserving shoulder arthroplasty implants, second-generation reverse total shoulder arthroplasties, and fracture-specific solutions.
"Careful attention to surgical technique combined with design improvements, such as ultrashort stem implants and bone-preserving glenoid components, allows us to perform the procedure in a way much less invasive than it was ever possible," explains Steven J. Hattrup, M.D., another Mayo orthopedic surgeon who specializes in shoulder repair.
The research edge
In addition to experience and expertise, another key factor contributing to Mayo Clinic's success in total shoulder arthroplasty with younger arthritis patients is its research base. Investigators are constantly evaluating design, materials and methods in search of improving outcomes.
An important advantage to master the latest techniques is the fact that Mayo specialists are active leaders collaborating in the innovation process that creates new procedures. Explains Dr. Sanchez-Sotelo: "Physicians may be reluctant to refer patients under 65 years old for total shoulder arthroplasty due to the perceived risk and conventional teaching regarding implant failure and the prospect of revision. At Mayo Clinic, we believe that shoulder arthroplasty is approaching the long-term reliability of hip and knee arthroplasty thanks to the development and careful evaluation of bone-preserving implants. We collaborate with patients and their physicians to choose the implant design that works best for each individualized case, and have the widest set of options available anywhere, in terms of skills, experience, materials and methods."
Indications for total shoulder arthroplasty
Indications for total shoulder arthroplasty in the young adult with arthritis include:
- Pain that is refractory to nonsurgical treatments such as rest, anti-inflammatory medications and physical therapy
- Intact, functioning rotator cuff and deltoid
- Sufficient glenoid bone stock
- Motivated patient able to follow aftercare reconditioning and rehabilitation protocols to recover stability and function