Our Summary

This research paper is about a study conducted on patients with shoulder arthritis (specifically glenohumeral osteoarthritis, GH-OA). The study was testing whether an injection of a substance called autologous conditioned serum (ACS) could help reduce the symptoms of the disease and delay the need for shoulder replacement surgery. ACS is made from the patient’s own blood and is used to reduce inflammation.

The study involved 36 patients (40 shoulders in total), who were given up to six weekly injections of ACS. The researchers then took various measurements of their condition, including how much pain they were in, how much they could move their shoulder, and their scores on several tests designed to measure shoulder health. These measurements were taken both before the injections and three months after the treatment.

The results showed that, three months after the injections, on average patients had significantly less pain, could move their shoulder more, and had better scores on the health tests. However, 16 of the shoulders ended up needing a replacement anyway. In nine of these cases, the need for replacement came quickly (within around seven months), while in the other seven cases, the injections delayed the need for a replacement for an average of around three years. The other 18 shoulders showed significant improvement and didn’t need a replacement at the time of the follow-up (around three and a half years later).

The researchers concluded that ACS injections can help reduce pain and disability in patients with GH-OA and can delay the need for shoulder replacement surgery. They didn’t find any relationship between the severity of the arthritis (measured by the glenoid Walch score or joint space) and the outcomes of the treatment.

FAQs

  1. What is Autologous conditioned serum (ACS) and how does it help in the treatment of glenohumeral osteoarthritis (GH-OA)?
  2. What were the improvements seen in patients with GH-OA after receiving intra-articular injections of ACS?
  3. Can ACS injections delay the need for a shoulder replacement in patients with GH-OA?

Doctor’s Tip

A helpful tip a doctor might tell a patient about shoulder replacement is to consider trying non-surgical treatments such as intra-articular injections of autologous conditioned serum (ACS) before opting for surgery. This treatment can help reduce pain and delay the need for a shoulder replacement in some cases. It is important to discuss all options with your doctor to determine the best course of action for your individual situation.

Suitable For

Patients with glenohumeral osteoarthritis who are experiencing pain and disability may be recommended for shoulder replacement. In some cases, patients may be able to delay the need for a shoulder replacement by receiving intra-articular injections of autologous conditioned serum (ACS) to reduce inflammation and improve symptoms. This non-operative management approach can be beneficial for patients with GH-OA who are not yet ready for shoulder replacement surgery.

Timeline

Before the shoulder replacement, a patient with glenohumeral osteoarthritis (GH-OA) may experience pain, limited range of motion, and disability in the affected shoulder. They may undergo non-surgical treatments such as Autologous conditioned serum (ACS) injections to reduce pain and inflammation.

After receiving up to 6 weekly ACS injections, patients may experience improvements in pain, range of motion, and shoulder function. At 3 months post-treatment, patients may see statistically significant improvements in Shoulder Pain And Disability Index (SPADI), Constant score, Visual Analogue Scale (VAS) pain, and range of motion.

Some patients may eventually progress to a shoulder replacement, with some cases happening quickly and others being delayed by several years. However, for some patients, ACS injections may provide significant pain relief and functional improvement, leading to a delay in the need for a shoulder replacement. Overall, ACS injections in the shoulder joint for GH-OA can reduce pain and disability, and potentially postpone the need for a shoulder replacement.

What to Ask Your Doctor

  1. What is autologous conditioned serum (ACS) and how does it work to improve symptoms of glenohumeral osteoarthritis (GH-OA)?

  2. How many intra-articular injections of ACS will I need and how often will I need them?

  3. What imaging tests will be done to assess the severity of my GH-OA before and after treatment with ACS injections?

  4. What specific measurements will be used to track my progress, such as range of motion, visual analogue scale (VAS) pain, Shoulder Pain And Disability Index (SPADI), American Shoulder and Elbow Surgeons and Constant scores?

  5. What are the potential risks and side effects associated with ACS injections in the shoulder joint?

  6. How long can I expect the benefits of ACS injections to last before needing a shoulder replacement?

  7. Will I still be able to pursue non-surgical treatments for GH-OA after receiving ACS injections, if needed in the future?

  8. Are there any specific lifestyle changes or physical therapy exercises that I should incorporate into my treatment plan alongside ACS injections?

  9. How will you determine if I am a good candidate for ACS injections for GH-OA?

  10. What is the success rate of ACS injections in delaying the need for a shoulder replacement in patients with GH-OA?

Reference

Authors: Simon MJK, Aartsen VE, Coghlan JA, Strahl A, Bell SN. Journal: ANZ J Surg. 2021 Apr;91(4):673-679. doi: 10.1111/ans.16672. Epub 2021 Feb 20. PMID: 33609074