Editorial Commentary: Arthroscopic Treatment of Glenohumeral Arthritis-Avoiding Heavy Metal!

Arthroscopic treatment of glenohumeral arthritis is an important option in young or active patients in whom arthroplasty is not desired or ideal. Typically, arthroscopic management is a bridging procedure with the goals of decreasing pain, improving function, and delaying the need for shoulder arthroplasty. Many levels of treatment have been described ranging from simple to complex-from joint lavage to glenohumeral ligament release and loose body removal to comprehensive arthroscopic management, which includes glenohumeral chondroplasty, synovectomy, loose body removal, microfracture, capsular release, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, and biceps tenodesis. Patient selection and education are essential because patients with end-stage arthritis (<2 mm of joint space) and bony deformity of the glenoid or humerus have less favorable long-term survival. We prefer the comprehensive arthroscopic management approach, although more technically difficult, because it attempts to address the greatest amount of pathology. We believe this permits the maximum likelihood of sustained benefit and avoidance of "heavy metal," with a 60% survival rate at minimum 10-year follow-up.