TSA vs RSA in Glenohumeral Osteoarthritis

Launched by OTTAWA HOSPITAL RESEARCH INSTITUTE · Jan 13, 2020

Keywords

ClinConnect Summary

This clinical trial is comparing two types of shoulder surgery—total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA)—to see which option is better for older patients with shoulder osteoarthritis. Osteoarthritis is a condition that causes pain and stiffness in the joints, and this study is focusing on patients who are 65 years and older and have already tried other treatments for at least six months without relief. To qualify, participants need to have significant wear and tear in the cartilage of their shoulder, and their shoulder joint must have a specific alignment issue called glenoid retroversion.

If you or a loved one is over 65 and struggling with shoulder pain that hasn’t improved with medication, physical therapy, or lifestyle changes, you might be eligible to participate in this study. Participants will receive one of the two surgical treatments and will be monitored over time to see how well they recover and manage their pain. It's important to note that individuals with certain conditions, like infections or previous shoulder surgeries, may not be able to join. This trial aims to help find the best surgical approach for older adults facing these shoulder challenges.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• 1. Patients who have failed standard non-surgical management of their idiopathic shoulder osteoarthritis who would benefit from a shoulder arthroplasty. Failed medical management will be defined as persistent pain and disability despite adequate standard non-operative management for 6 months. Medical management will be defined as:
• • 1. The use of drugs including analgesics and non-steroidal anti-inflammatory drugs
• • 2. Physiotherapy consisting of stretching, strengthening and local modalities (ultrasound, cryotherapy, etc.)
• • 3. Activity modification
• • 2. Imaging, and intra-operative findings confirming advanced glenohumeral cartilage loss
• • 3. Patients may present with a glenoid deficiency and \</=15 degrees of retroversion
• • 4. 65 years of age and older
• Exclusion Criteria:
• • 1. Active joint or systemic infection
• • 2. Rotator cuff arthropathy
• • 3. Significant muscle paralysis
• • 4. Charcot's arthropathy
• • 5. Major medical illness (life expectancy less than 1 year or unacceptably high operative risk)
• • 6. Unable to understand the consent form/process
• • 7. Pregnancy
• • 8. Psychiatric illness that precludes informed consent
• • 9. Unwilling to be followed for the duration of the study
• • 10. Retroversion cannot be surgically corrected to within 10 degrees of neutral
• • 11. History of previous shoulder surgery on affected side