Bone loss in shoulder instability and shoulder arthroplasty

We are excited to present a special series in Annals of Joint on bone loss in shoulder surgery. This series will discuss two hot topics in shoulder surgery, including (I) bone loss in anterior and posterior shoulder instability, focusing on current controversies and treatment approaches for both glenoid and humeral head bone loss and (II) treatment approaches to bone loss during shoulder arthroplasty.

Bone loss in shoulder surgery is exceptionally challenging to treat, especially as the incidence of bone loss continues to be more prevalent as patients remain physically active for longer duration. It is important to remain current on technological advances and surgical approaches to these complex problems in order to maximize patient reported outcomes and minimize complications, including recurrence and revision surgery.

Successful outcomes of surgical intervention for anterior and posterior shoulder instability necessitates careful consideration of glenoid bone loss, both anterior and posterior, as well as osseous defects in the humeral head. Current controversies surround timing and approach to these complex problems, including immediate versus delayed surgery, open versus arthroscopic surgery, all soft tissue versus bone block procedures. Subcritical and critical bone loss on the glenoid, as well as bipolar bone loss and distance to dislocation, have recently been identified as risk factors for surgical failure and require careful consideration and preoperative planning. This special series will delve into each instability pattern as well as provide an in-depth approach into the workup, management, and surgical approach.

There has been a drastic rise in number of shoulder arthroplasties performed over the past 20 years. Many of these patients will present with glenoid bone loss, both in the primary and revision settings, which can be challenging to the treating surgeon and increase risk of complications including implant loosening and failure. This series will detail current literature on management and treatment approaches to these complex surgical entities, in both the primary and revision settings.

Hopefully this series provides the reader with a thorough and up to date review of bone loss in shoulder surgery as well as providing a detailed treatment algorithm to maximize surgical outcomes and minimize perioperative and postoperative complications.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Joint for the series “Bone Loss in Shoulder Instability and Shoulder Arthroplasty”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-24-34/coif). The series “Bone Loss in Shoulder Instability and Shoulder Arthroplasty” was commissioned by the editorial office without any funding or sponsorship. J.D.H. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Joint from July 2024 to December 2026. A.L. served as the unpaid Guest Editor of the series and serves as the Editor-in-Chief of Annals of Joint from February 2024 to January 2029. A.L. reports receiving research grants from the National Institute of Health (NIH R21, Grant AR078418-01; NIH R03, Grant 12731062; and NIH R01, Grant AR080435), royalties or licenses from Arthrex, Inc., consulting fees from Arthrex, Inc., Stryker, and Restor3d, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Arthrex, Inc., Stryker, and ConMed, and support for attending meetings and/or travel from Arthrex, Inc., Stryker, and Smith & Nephew. A.L. serves on a Data Safety Monitoring Board or Advisory Board of Restor3d, has been the co-chair for the ASES Fellows’ Day Symposium 2021 and 2022, and is an active committee member of the American Shoulder and Elbow Surgeons (ASES), the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS), as well as a member of the AAOS Appropriate Use Criteria Committee for rotator cuff tears. He also serves as the Associate Editor of JBJS Case Connector. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Jonathan D. Hughes

Albert Lin