Management of Glenohumeral Joint Osteoarthritis

Hyaluronic Acid

• rec_1

  Strong evidence supports that there is no benefit to the use of hyaluronic acid in the treatment of glenohumeral joint osteoarthritis.

  StrongEvidence: HighTreatment

Prognostic Factors (BMI)

• rec_2

  Strong evidence suggests that obese patients with glenohumeral osteoarthritis do not experience an increase in the rate of early post-operative complications.

  StrongEvidence: HighPrognosis

Prognostic Factors (Gender/sex)

• rec_3

  Strong evidence supports that gender/sex is not associated with better or worse post-operative outcomes.

  StrongEvidence: HighPrognosis

Prognostic Factors (Comorbidities)

• rec_4

  Strong evidence suggests that patients with glenohumeral joint osteoarthritis who have more comorbidities experience higher rates of early post-arthroplasty complications.

  StrongEvidence: HighPrognosis

Total Shoulder Arthroplasty

• rec_5

  Strong evidence supports that anatomic total shoulder arthroplasty demonstrates more favorable function and pain relief in the short- to mid-term follow-up when compared to hemiarthroplasty for the treatment of glenohumeral osteoarthritis.

  StrongEvidence: HighTreatment

Glenoid Component - Pegged or Keeled

• rec_6

  Strong evidence supports that the clinician may utilize pegged or keeled glenoid components in patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff. Pegged components demonstrate less radiolucent lines, but the effect on clinical outcomes and survivorship are unclear.

  StrongEvidence: HighTreatment

Prognostic Factors (Age)

• rec_7

  Moderate evidence supports that older age at the time of surgery is associated with lower revision rates.

  ModerateEvidence: ModeratePrognosis

Prognostic Factors (Smoking)

• rec_8

  Moderate evidence suggests that smoking is associated with inferior post-operative outcomes.

  ModerateEvidence: ModeratePrognosis

Prognostic Factors (Pre-Operative Function)

• rec_9

  Moderate quality evidence suggests that, while both higher and lower pre-operative functioning patients with glenohumeral joint osteoarthritis will likely experience improvement following arthroplasty, patients with higher pre-operative function may experience less functional improvement.

  ModerateEvidence: ModeratePrognosis

Prognostic Factors (Depression)

• rec_10

  Moderate evidence suggests that depression is associated with inferior post-operative outcomes in patients with glenohumeral joint osteoarthritis undergoing arthroplasty.

  ModerateEvidence: ModeratePrognosis

Glenoid Component - Metal Backed Cementless

• rec_11

  Moderate evidence supports that surgeons not use metal-backed cementless glenoid components.

  ModerateEvidence: ModerateTreatment

Total Shoulder Arthroplasty - Subscapularis Peel, Lesser Tuberosity Osteotomy, Tenotomy

• rec_12

  Moderate quality evidence supports that surgeons can utilize subscapularis peel, lesser tuberosity osteotomy, or tenotomy when performing shoulder arthroplasty.

  ModerateEvidence: ModerateTreatment

Hemiarthroplasty - Stems

• rec_13

  Limited evidence supports that clinicians may utilize stemmed, stemless or resurfacing prosthesis for patients with glenohumeral joint osteoarthritis undergoing total or hemi-arthroplasty.

  LimitedEvidence: LowTreatment

Pre-Operative Physical Therapy

• rec_14

  In the absence of reliable evidence, it is the opinion of the work group that physical therapy may benefit select patients with glenohumeral joint osteoarthritis.

  ConsensusEvidence: No reliable evidenceTreatment

Post-Operative Physical Therapy

• rec_15

  In the absence of reliable evidence, it is the opinion of the work group that clinicians may prescribe physical therapy in patients following shoulder arthroplasty.

  ConsensusEvidence: No reliable evidenceTreatment

Injectable Biologics

• rec_16

  In the absence of reliable evidence, it is the opinion of the work group that injectable biologics, such as stem cells or platelet-rich plasma, cannot be recommended in the treatment of glenohumeral osteoarthritis.

  ConsensusEvidence: No reliable evidenceTreatment

Alternative Non-Surgical Treatments

• rec_17

  In the absence of reliable evidence, the work group cannot recommend for or against the use of the following: Acupuncture, Dry needling, Cannabis, Cannabodiol (CBD) oil, Capsaicin, Shark cartilage, Glucosamine and chondroitin, Cupping, Transcutaneous Electrical Nerve Stimulation (TENS)

  ConsensusEvidence: No reliable evidenceTreatment

Opioid Pain Medication

• rec_18

  In the absence of reliable evidence, it is the opinion of the work group that opioids not be prescribed as routine and long-term pain management of glenohumeral osteoarthritis.

  ConsensusEvidence: No reliable evidenceTreatment

Non-Prosthetic Surgical Options

• rec_19

  In the absence of reliable evidence, it is the opinion of the work group that non-prosthetic surgical options may or may not provide short-term benefit for patients with glenohumeral joint osteoarthritis.

  ConsensusEvidence: No reliable evidenceTreatment

Radiographs

• rec_20

  In the absence of reliable evidence, it is the opinion of the work group that patients with glenohumeral osteoarthritis undergoing arthroplasty should be imaged with axillary and true AP (Grashey view) radiographs, with advanced imaging performed at the discretion of the clinician.

  ConsensusEvidence: No reliable evidenceDiagnosis

Cemented Stems

• rec_21

  In the absence of reliable evidence, it is the opinion of the work group that either cemented or cementless stems can be utilized in the treatment of patients with glenohumeral joint osteoarthritis and a well-functioning rotator cuff.

  ConsensusEvidence: No reliable evidenceTreatment

Anatomic/ Reverse Total Shoulder Arthroplasty

• rec_22

  In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use either anatomic total shoulder arthroplasty (TSA) or reverse TSA for the treatment of glenohumeral joint osteoarthritis in select patients with excessive glenoid bone loss and/or rotator cuff dysfunction.

  ConsensusEvidence: No reliable evidenceTreatment

Glenoid Components - Polyethylene-Metal or All-Polyethylene

• rec_23

  In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use polyethylene-metal hybrid glenoid components or all-polyethylene components during total shoulder arthroplasty for treatment of glenohumeral joint osteoarthritis.

  ConsensusEvidence: No reliable evidenceTreatment

Biceps Tenodesis and Tenotomy

• rec_24

  In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may consider concomitant biceps tenodesis or tenotomy during shoulder arthroplasty.

  ConsensusEvidence: No reliable evidenceTreatment

Tranexemic Acid

• rec_25

  In the absence of reliable evidence, it is the opinion of the workgroup that utilization of tranexamic acid during shoulder arthroplasty may result in reduced blood loss and reduced risk of blood transfusion.

  ConsensusEvidence: No reliable evidenceTreatment

Supraspinatus Tears

• rec_26

  In the absence of reliable evidence, it is the opinion of the workgroup that, for patients with small isolated, repairable supraspinatus tears, clinicians can perform anatomic total shoulder arthroplasty.

  ConsensusEvidence: No reliable evidenceTreatment

Discharge

• rec_27

  In the absence of reliable evidence, it is the opinion of the workgroup that same-day discharge is an option after shoulder arthroplasty in select patients.

  ConsensusEvidence: No reliable evidenceManagement

Cryotherapy

• rec_28

  In the absence of reliable evidence, it is the opinion of the workgroup that either continuous cryotherapy or cold packs can be used following shoulder arthroplasty.

  ConsensusEvidence: No reliable evidenceManagement

Multimodal Pain Management

• rec_29

  In the absence of reliable evidence, it is the opinion of the workgroup that multimodal pain management strategies or non-opioid individual modalities can provide added benefit for postoperative pain management following shoulder arthroplasty.

  ConsensusEvidence: No reliable evidenceTreatment

Therapeutic Area

Guideline Scope

Inclusion Criteria

• Primary glenohumeral joint osteoarthritis

Exclusion Criteria

• Rheumatoid arthritis
• Inflammatory arthritis
• Post traumatic arthritis
• Avascular necrosis
• Rotator cuff tear arthropathy
• Capsulorrhaphy arthropathy
• Post-infectious arthropathy

Care Settings

Special Populations

Evidence Distribution

Evidence Levels

Recommendation Strength