Shoulder osteoarthritis: Local and surgical treatments

Injections may be prescribed for osteoarthritis when the anti-inflammatory drugs and analgesics have failed to relieve a flare-up.

This technique involves injecting an anti-inflammatory cortisone-based product directly into the joint. Cortisone has the advantage of acting on both pain and inflammation. In no case does it damage the cartilage; but some patients on seeing their painful symptoms regress or even disappear push their joint too hard at a time when it is still fragile.

The injection generally gets good results because the majority of the injected product remains in the joint. It acts on the pain and swelling within a few hours or days.

Its effect is prolonged, lasting from a few days to two months, depending on the case.

Injections are often feared but, in actual fact, they are not really worse than a blood test if your doctor is experienced. However, it is always possible and sometimes useful to use a local anaesthetic beforehand.

Go easy on your joints for a few hours after the injection. Sometimes the pain increases for several hours following the injection. These problems disappear spontaneously within a few hours and are not a contraindication for further injections.

However, for pain that occurs 48 hours after the injection, you should go and see your doctor immediately to rule out the possibility of an infection. Although this risk is very low (1 in 50,000 injections) you need to be particularly vigilant.

There is no need for a special diet: the passage in the blood of cortisone administered locally is far too low to lead to weight gain. However, if you have diabetes, this may cause a temporary imbalance.

It is recommended not to perform more than three injections per year per joint for the simple reason that if the first three did not have a sufficient effect, it is unlikely that the fourth will be more effective.

Keep track in a notebook or your health record of the date, the product used and the effectiveness of the injection.

In young subjects with incipient osteoarthritis, arthroscopy can be performed. It enables carrying out a joint lavage in order to improve mobility, eliminate the phenomena of blockage by removing foreign bodies, reduce the frequency of effusions and ease pain.

The operation requires a short hospital stay (24 to 48 hours). This procedure is carried out under local, general or epidural anaesthesia in an operating room. It involves introducing a small camera into the centre of the affected joint to assess the lesions caused by osteoarthritis.

It also enables performing joint "cleansing" to rid the joint of cartilage or meniscal fragments either by performing a JOINT LAVAGE or directly using a clamp. The practitioner can, in fact, introduce the necessary instruments thanks to two incisions. He or she can also regularise the joint surfaces.

A variable rest period is recommended for the joint after this treatment. Complications that may arise are those related to any surgical procedure (complications of anaesthesia, risk of phlebitis, pulmonary embolism) and those related to surgery on a joint (infections, reflex sympathetic dystrophy).

This is to replace a joint badly damaged by osteoarthritis by a joint in synthetic material. The indication is never urgent because it is primarily to improve comfort. The surgical decision is the result of discussions between yourself, your doctor and the surgeon.

The results are generally good with a reduction of pain associated with osteoarthritis and a satisfactory restoration of mobility. However, you should keep in mind that a prosthetic joint rarely functions as well as a normal joint. The techniques with the safest and best results are currently those used for hips and knees.

These are mainly knee joints and hip joints. The prostheses are made of different materials and attached to the bone with a special cement or "biological glues".

The procedure is done under general or local-regional anaesthesia. It also includes a self-transfusion (sample of your own blood before surgery for you if a transfusion is required during surgery). This technique removes all the risks of a transfusion.

Hospitalisation lasts about a week, but a stay of 4 to 6 weeks straight afterwards in a rehabilitation centre is desirable.

In all cases these procedures are necessary only when all other medical treatments have failed. The materials used have the disadvantage of wearing out after 15 to 20 years and even faster in young and active people. This is why a prosthesis is not generally proposed to people under the age of 55 to 60 years (except in special cases).

Preparation is necessary:
 

• strength training for the muscles that will surround the future prosthesis,
• weight loss in cases of obesity,
• eliminating any source of infection (teeth, sinuses, etc.).

Some surgeons recommend a period of one to several months after the last injection of corticosteroids and the operation in order to be safe from any potential infection with the corticosteroids. The risks are those of any surgical procedure but there can be specific complications with prostheses: the prosthesis may become detached from the bone to which it had been fixed:
 

• it sometimes loosens due to infection (1-2%),
• poor positioning of the prosthesis and lastly much less serious,
• painful muscle or tendon problems that disappear with proper rehabilitation.