Arthroscopic debridement in the management of glenohumeral osteoarthritis: long-term results (SS-20)

      Arthroscopic debridement for osteoarthritis has shown optimistic results in several recent studies with short-term follow-up. Long-term results and the effect of debridement on progression of disease remains unknown. Seventy-five patients presented to the senior author over a 12 year period with osteoarthritis treated with arthroscopic debridement. Thirty-five patients were available for follow-up greater than five years with radiographs and clinical examination and formed the basis of this study. Mean age was 45.8 years, mean follow-up 7.3 years. While good initial response to debridement was noted at the six month point in 92% of patients based on UCLA and ASES scores, only 28% of patients showed good or excellent results at long-term follow-up. All patients showed significant radiographic progression of disease. 15 patients converted to total shoulder replacement over the course of the study. Survivorship analysis showed a 62% five year survivor ship using arthroplasty as an endpoint. While arthroscopic debridement provides short-term relief in many patients, long-term relief is not common, and interval progression is nearly universal, often requiring shoulder replacement at an age where arthroplasty is not desirable despite debridement. The long-term outcome of arthroplasty is not ideal in the younger patient, and arthroscopic debridement remains a viable option for the younger patient with glenohumeral arthritis. It however shows minimal long-term relief of symptoms, and does not significantly alter progression of disease. Patients with glenohumeral arthritis should be cautioned that short-term relief with arthroscopic debridement is the norm, and progression of disease is not commonly affected by arthroscopic debridement. Arthroscopic debridement does not routinely provide sufficient long-term relief to allow delay of shoulder arthroplasty to an appropriate age in most young patients.