With the increase in life expectancy and willingness of the population to stay fit and healthy, orthopaedic surgeons now face more patients with conditions linked to degenerative articular cartilage and wear of joints. For orthopaedic surgeons focused on the upper extremities, shoulder replacement surgery has almost become a routine practice. More ambitious outcomes for shoulder joint replacement, such as a greater ability to resume sports and return to work, are in the pipeline. In the format of an Interactive Expert Exchange (IEE) session, our 2018 Congress in Barcelona will showcase the key medical problems around primary shoulder osteoarthritis, with a particular focus on patients younger than 50 years of age.
Friday 1 June 2018 | 10:15 to 12:30
Primary Shoulder Osteoarthritis in Patients Under 50
Introduction & Conclusions
Markus Loew (Germany)
Questions & Presentations
- Physio, Injections, Arthroscopy or Arthroplasty – Guidelines for Decision-making | Eran Maman (Israel)
- Arthroscopic Treatment of Osteoarthritis – CAM Procedure | Ofer Levy (United Kingdom)
- Resurfacing, Hemi or Total Shoulder Arthroplasty in Younger Patients | Fernando Santana (Spain)
- Pyrocarbon Heads in Hemiarthroplasty – Is This the Future? | Alexander Van Togel (Belgium)
- What to Do with a Very Bad Glenoid in Younger Patients | Patric Raiss (Germany)
Clinical Cases - Discussion
Provocateurs: Ofer Levy (United Kingdom) & Markus Loew (Germany)
Shoulder OA, together with the pain and physical limitations linked to it, develops with age. However, some types of injury, like dislocation, can lead to this degenerative condition even in young and active patients.
Due to the general limitations in the endurance of implants, an initial indication for surgery must be carefully weighed before recommended to the patient. Indeed, in some cases, shoulder recovery based on conservative treatments, such as physiotherapy and/or joint-preserving techniques, can avoid the need for an invasive procedure. If a conservative approach can delay shoulder arthroplasty without compromising favorable functional and clinical results, it should be favored. In the decision-making process, risk factors for early deterioration, such as glenoid deformities, are as important as muscle status or the patient’s particular demands. Moreover, under certain circumstances, comprehensive arthroscopic management can improve pain and range of motion in arthritic shoulders, as well as decelerate the progress of the disease. Therefore, training for this specific medical technique provides a big advantage within an orthopaedic residency program.
However, and despite the surgeon’s experience, problems can still arise in the patient’s operative follow-up, especially in instances of severe glenoid deformities, where the timing can compromise the chance to adjust a prosthesis to the arthritic joint. In younger patients, the possibility to use new materials that are potentially more durable than the time-tested metallic and polyethylene implants, should always be considered. Nevertheless, the same basic considerations apply to young or elderly patients: Total shoulder arthroplasty performs better than hemiarthroplasty and, among all the treatment options, reverse shoulder arthroplasty should be used as a last resort.
This IEE will guide the attendees through the careful considerations to treat shoulder OA and better plan any necessary surgical procedure, particularly in younger and more active patients. As surgical treatment is crucial for a good outcome in less than 50% of patients younger than 50 years of age, presentations will include discussions on conservative treatments like physiotherapy with muscle-balancing, which is often enough in most younger patients. Still, among the surgical approaches, the CAM-impingement procedure and hemiarthroplasty with pyrocarbon heads will be put forward because these represent standard approaches reserved for younger patients. In this age group, long-term functionality is the most important objective to reach and especially for the populations that are at-risk, which include overhead workers and throwing athletes.
The format of this exchange, including lectures, open debates and case presentations, will lead to a deep evaluation of all available treatments and highlight the key considerations for the surgeon to improve the general outcome of patients undergoing this procedure. The highly experienced surgeons in the specialty of shoulder arthroplasty will discuss pros and cons of each possibility to help the attendees’ decision-making and daily practice.
The IEEs are paying sessions and preregistration is mandatory (up to a maximum of 200 participants) on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the congress. All details to sign-up will be available on our registration platform as of January 2018. Please visit our 2018 congress website regularly.