Treatment Options for Bilateral Glenohumeral Joint Osteoarthritis After Failed Steroid Injections

Non-Surgical Options After Failed Steroid Injections

The American Academy of Orthopaedic Surgeons (AAOS) recommends injectable viscosupplementation as an option when treating patients with glenohumeral osteoarthritis who have failed steroid injections, with a Grade C recommendation based on Level IV evidence 2
Viscosupplementation is typically administered as three weekly injections of hyaluronic acid preparations, and studies have shown improvements in pain scores, Simple Shoulder Test (SST), and University of California, Los Angeles (UCLA) scores at 1, 3, and 6 months after treatment 2
Monitor for short-term pain relief after injection while continuing appropriate physical therapy, although the strength of evidence for this is not specified 3

The AAOS is unable to recommend for or against arthroscopic treatments for glenohumeral OA (Grade I recommendation, Level V evidence), but arthroscopic options may be considered for younger patients with early-stage OA who may not be candidates for arthroplasty 2
Total shoulder arthroplasty (TSA) and hemiarthroplasty are both options for treating glenohumeral OA (Grade C recommendation, Levels IV and V evidence), with TSA recommended over hemiarthroplasty as it provides better outcomes (moderate-rated recommendation) 5, 6
TSA provides significant improvements in pain, global health assessment, function, and quality-of-life scores, and is preferred over hemiarthroplasty for older patients with advanced OA 5, 6
Hemiarthroplasty may be appropriate when the glenoid is naturally concentric or can be reamed to concentricity 5
Concern exists about performing shoulder arthroplasty in patients under 50 years due to potential increased risk of prosthetic loosening and decreased survivorship, and surgeons who perform fewer than two shoulder arthroplasties per year should avoid performing these procedures to reduce immediate postoperative complications 5, 2, 6
When performing TSA, keeled or pegged all-polyethylene cemented glenoid components are recommended 6

The quality of scientific data on management of glenohumeral OA is limited, with none of the AAOS recommendations receiving Grade A ratings, and proper patient selection for each treatment modality is crucial based on age, activity level, and disease severity 4
For surgical interventions, refer to high-volume shoulder surgeons (those performing more than two shoulder arthroplasties per year) to reduce complications 6
Monitor for complications after injections, including post-injection pain flares, although the strength of evidence for this is not specified 3