Treatment of Glenohumeral Joint Space Narrowing

Initial Conservative Management

The American Academy of Orthopaedic Surgeons recommends treatment be dictated by patient age, severity of symptoms, radiographic findings, and medical comorbidities 1, 2
Conservative options include physical therapy, though it lacks high-quality evidence supporting its efficacy 3, 1
Pharmacotherapy is extrapolated from hip and knee osteoarthritis literature, with limited specific evidence for glenohumeral OA 1, 2
The use of injectable corticosteroids has insufficient evidence to recommend for or against their use (Grade I recommendation) 3, 4
Viscosupplementation is a treatment option with a weak recommendation 1, 2

The American Academy of Orthopaedic Surgeons recommends total shoulder arthroplasty (TSA) over hemiarthroplasty, with moderate-strength evidence 5, 1, 2
TSA provides superior clinical outcomes compared to hemiarthroplasty for advanced glenohumeral osteoarthritis 6
TSA should not be performed in patients with irreparable rotator cuff tears, according to the American Academy of Orthopaedic Surgeons consensus recommendation 1, 2, 7, 8
Reverse total shoulder arthroplasty may be considered as an alternative in cases with irreparable rotator cuff tears 6

The American Academy of Orthopaedic Surgeons recommends using mechanical and/or chemical venous thromboembolism prophylaxis for all shoulder arthroplasty patients (consensus recommendation) 1, 2, 7, 8

Physical therapy following shoulder arthroplasty is commonly practiced, but no high-quality studies demonstrate whether it improves outcomes (Grade I recommendation) 9

The American Academy of Orthopaedic Surgeons notes that most recommendations are extrapolated from hip/knee literature rather than shoulder-specific studies 5, 1
Pre-operative imaging is essential to evaluate glenoid morphology, bone loss, retroversion, and bone quality before arthroplasty 10
Shoulder arthroplasty complications occur in up to 39.8% of cases, with revision rates up to 11% 6
The most common complications differ by procedure type, including glenoid erosion (20.6%) for hemiarthroplasty, glenoid loosening (14.3%) for TSA, and scapular notching, dislocation, periprosthetic fractures for reverse TSA 6

The American Academy of Orthopaedic Surgeons recommends total shoulder arthroplasty (TSA) as the preferred treatment for severe glenohumeral joint narrowing with hypertrophic spurring, providing superior pain relief and lower revision rates compared to hemiarthroplasty, with moderate-strength evidence (Grade B recommendation) 11, 12
Viscosupplementation (hyaluronic acid injections) is a treatment option with weak supporting evidence (Grade C recommendation) 13
Corticosteroid injections have insufficient evidence to recommend for or against use (Grade I recommendation) 13

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 11, 12
Both TSA and hemiarthroplasty significantly improve pain, function, and quality-of-life scores, but TSA demonstrates better outcomes 11, 12, 13

Avoid arthroplasty in patients <50 years when possible due to increased risk of prosthetic loosening and decreased survivorship 12, 13

Surgeon volume matters, with a recommendation to avoid surgeons performing <2 shoulder arthroplasties per year to reduce immediate postoperative complications and length of stay (Grade C recommendation) 11

Corticosteroid injections for glenohumeral osteoarthritis have insufficient evidence to support a recommendation for or against their use (Grade I recommendation). This reflects the American Academy of Orthopaedic Surgeons (AAOS) assessment of the current literature. 14
Viscosupplementation with intra‑articular hyaluronic acid provides weak evidence of benefit (Grade C recommendation) for pain relief in glenohumeral osteoarthritis. This recommendation is also from the AAOS. 14
An industry‑supported study reported clinical improvement after three weekly intra‑articular injections of Hylan G‑F 20 in patients with glenohumeral osteoarthritis. Evidence originates from the AAOS guideline source. 14

In patients with an intact rotator cuff, total shoulder arthroplasty (TSA) yields superior pain relief and functional outcomes compared with hemiarthroplasty (Grade B recommendation, moderate‑quality evidence). Recommendation is based on AAOS guidance. [14][15]
For patients younger than 50 years, arthroplasty should be avoided when possible because of a higher risk of prosthetic loosening and reduced implant survivorship. This recommendation is derived from AAOS evidence. 14

The AAOS clinical practice guideline on glenohumeral osteoarthritis contains nine inconclusive recommendations out of a total of sixteen, highlighting the limited high‑quality evidence specific to the shoulder joint. This reflects the overall evidence quality noted by the AAOS. 15