This narrative review addresses how to manage glenohumeral arthritis in patients under 50-55 years old. It surveys the arthroplasty options and their tradeoffs. The central question is how to balance predictable pain relief against the high long-term glenoid loosening rates that limit total shoulder arthroplasty in young, active patients.
The whole decision tree in the young shoulder hinges on one problem: the glenoid component loosens. Almost a third loosen radiographically by 10 years, and in patients under 56 the revision rate for glenoid loosening jumps from 2% at 5 years to 38% at 10 years. That is why the strategy shifts toward preserving glenoid bone and choosing implants that make revision easier.
Use a mental algorithm. High-demand patient without glenoid degeneration: humeral resurfacing or humeral head replacement. High-demand patient with glenoid arthritis: consider ream-and-run. Low-demand young patient: total shoulder arthroplasty gives the most predictable relief.
Know the pitfalls. Biologic glenoid resurfacing fails around half the time and remains controversial. Resurfacing needs roughly 60% of the native head, so large humeral defects rule it out. Reverse TSA works but carries substantial complication and notching rates in this age group.
This narrative review addresses how to manage glenohumeral arthritis in patients under 50-55 years old. It surveys the arthroplasty options and their tradeoffs. The central question is how to balance predictable pain relief against the high long-term glenoid loosening rates that limit total shoulder arthroplasty in young, active patients.
The whole decision tree in the young shoulder hinges on one problem: the glenoid component loosens. Almost a third loosen radiographically by 10 years, and in patients under 56 the revision rate for glenoid loosening jumps from 2% at 5 years to 38% at 10 years. That is why the strategy shifts toward preserving glenoid bone and choosing implants that make revision easier.
Use a mental algorithm. High-demand patient without glenoid degeneration: humeral resurfacing or humeral head replacement. High-demand patient with glenoid arthritis: consider ream-and-run. Low-demand young patient: total shoulder arthroplasty gives the most predictable relief.
Know the pitfalls. Biologic glenoid resurfacing fails around half the time and remains controversial. Resurfacing needs roughly 60% of the native head, so large humeral defects rule it out. Reverse TSA works but carries substantial complication and notching rates in this age group.