Treatment Options for Shoulder Osteoarthritis

Initial Conservative Management

The American Academy of Orthopaedic Surgeons recommends exercise-based physical therapy as the foundation of treatment for glenohumeral osteoarthritis, though evidence quality is limited 1, 2
Exercise is strongly recommended for all patients with shoulder OA, with the primary goals of decreasing pain, increasing range of motion, and protecting the glenohumeral joint through rotator cuff strengthening 2
No specific exercise prescription (duration, intensity, frequency) has proven superior, so recommendations should focus on patient preference and access, including walking, cycling, resistance training, or neuromuscular training 2

Injectable corticosteroids have insufficient evidence to recommend for or against their use (Grade I recommendation), though they are widely used in clinical practice 1, 3
Viscosupplementation (hyaluronic acid injections) is an option (Grade C recommendation), typically administered as three weekly injections, with improvements in pain and function scores at 1, 3, and 6 months 1, 3, 4, 5

When conservative treatment fails, total shoulder arthroplasty (TSA) is preferred over hemiarthroplasty for patients with glenohumeral OA (Grade B recommendation, Level II evidence) 3, 4, 6
TSA provides statistically superior pain relief and global health assessment scores compared to hemiarthroplasty, with 14% of hemiarthroplasty patients requiring revision to TSA due to progressive glenoid arthrosis and pain 4, 6
Arthroscopic treatments have insufficient evidence to recommend for or against their use (Grade I recommendation), though they may be considered for younger patients with early-stage OA who are not candidates for arthroplasty 1, 3, 5

TSA should NOT be performed in patients with irreparable rotator cuff tears (consensus recommendation); reverse total shoulder arthroplasty should be considered instead 7, 6, 8
Avoid arthroplasty in patients under 50 years when possible due to increased risk of prosthetic loosening and decreased survivorship 1, 3, 6, 5
Refer to surgeons performing at least 2 shoulder arthroplasties per year to reduce immediate postoperative complications and length of stay 6, 5, 8

Use mechanical and/or chemical venous thromboembolism prophylaxis for all shoulder arthroplasty patients (consensus recommendation) 6, 8
Pre-operative imaging is essential to evaluate glenoid morphology, bone loss, retroversion, and bone quality before arthroplasty 6, 8
Shoulder arthroplasty complications occur in up to 39.8% of cases, with revision rates up to 11%, including glenoid erosion (20.6%) for hemiarthroplasty and glenoid loosening (14.3%) for TSA 6

Do not rely solely on corticosteroid injections, as evidence for their efficacy in glenohumeral OA is insufficient, and they should be used cautiously in athletes 1, 3
Do not perform traditional TSA in patients with irreparable rotator cuff tears, as this will lead to poor outcomes and likely revision surgery 7, 8
Do not extrapolate all treatment recommendations from hip and knee OA literature, as shoulder-specific evidence is limited and most recommendations are based on lower-quality evidence 6, 5