International consensus statement on the management of glenohumeral arthritis in patients ≤ 50 years old.

BACKGROUND: The purpose of this study was to implement a modified Delphi technique among a group of experts affiliated with American Shoulder and Elbow Surgeons (ASES) and European Society for Surgery of the Shoulder and Elbow (SECEC) to determine areas of consensus regarding what factors influence their decision to manage a patient surgically and what specific treatment modalities they utilize for patients ≤50 years of age with glenohumeral arthritis.

METHODS: The panel of experts comprised 168 shoulder and elbow specialists, 138 ASES and 30 SECEC members. In the first round, an open-ended questionnaire was utilized to solicit features that are important in making decisions regarding treatment. The second round involved ranking the features identified in the first round as to their importance in helping decision making for surgery. The results of round 2 were then utilized and 18 complex surgical cases previously treated by one of the lead authors were provided for the study. One additional case was included to address the management of Cutibacterium acne infection.

RESULTS: A total of 159 (95.0%) participants completed the round one survey, 142 (89%) responded to the second and third round surveys. In total 50 individual factors were positively associated with the decision to proceed with surgery. Ten of these were strongly supportive of surgery. Eight out of 18 clinical cases demonstrated > 80% agreement on the surgical treatment modality chosen. Over 90% of respondents chose reverse total shoulder arthroplasty (TSA) to manage pathology when an incompetent rotator cuff was present. Over 90% of respondents managed avascular necrosis with hemiarthroplasty. Over 70% of respondents chose anatomic TSA for inflammatory arthritis with low demand on their shoulder. Overall, 79% of respondents chose a stemless humeral component when a hemiarthroplasty or anatomic TSA was chosen in response to the proposed surgical cases. If arthroscopy was chosen then there was good agreement on 5 core procedures. There was only fair consensus on the approach to C. acnes in patients with glenohumeral osteoarthritis ≤ 50 years of age.

CONCLUSION: The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, and there are many treatment options to consider when responding to the variety of clinical presentations and anatomic pathologies. While physicians and patients engage in the shared decision-making process regarding the final choice for management, this consensus statement serves as a basis for discussion amongst colleagues and between patients and surgeons though it clearly demonstrates that the topic must be further investigated prospectively and with large cohorts.