Table 1

Procedures, advantages, and disadvantages for various surgical treatment modalities for severe osteoarthritis and rotator cuff disease

Surgical procedure

Advantages

Disadvantages


Osteoarthritis care

Arthroscopic debridement ± capsular release [18,19]

Low morbidity, low complication rate

Less predictable outcome

Joint preserving

Simple rehabilitation

Humeral head resurfacing with biologic interposition [21-23]

Avoids glenoid prosthesis

Mixed results

Obviates concerns over glenoid loosening over time

Less predictable pain relief

Theoretically, preserves bone stock for future reconstructive options

Revision surgery in event of failure

Hemiarthroplasty [28,33-36]

Avoids glenoid prosthesis

Less predictable pain relief

Obviates concerns over glenoid loosening over time

Increased time to maximal improvement

Shorter operation room time

Lower survival rate

Risk of glenoid bone loss over time

Revision surgery in event of failure

Total shoulder replacement [19,35,36]

Predictable pain relief

Risk of glenoid loosening

Predictable functional improvement

Proven longevity

Cartilage repair or grafting techniques [66,69,94]

Joint preserving

No long-term outcome result

Avoids or postpones arthroplasty procedure

Indicated in limited population, that is, young individuals with isolated defects

Rotator cuff disease care

Rotator cuff repair [20,40-42,55,57,59]

Favorable long-term outcome

Long recovery

Restores normal anatomy

Tendon healing unpredictable

Pain relief

Theoretically, protective against further degenerative changes in muscle and tendon

Debridement/biceps tenotomy/acromioplasty [95,96]

Indicated primarily for irreparable tear

Less predictable results

Pain relief

Further degenerative changes to bone and soft tissue structures possible

Lower morbidity than muscle transfer or arthroplasty

Muscle transfer [97]

Salvage procedure for irreparable cuff

Limited indications

Potentially restores strength

Mixed results

Pain relief

Long recovery period

Reverse shoulder arthroplasty [15,38,39]

Salvage procedure for irreparable tear

Higher morbidity and complication rate

Pain relief

Limited indications, that is, older patients

Restores function


Killian et al. Arthritis Research & Therapy 2012 14:214   doi:10.1186/ar3846