AAOS Releases New Appropriate Use Criteria

ROSEMONT, Ill. (APril 13, 2023)—The American Academy of Orthopaedic Surgeons (AAOS) recently released two new Appropriate Use Criteria (AUC) to address the most common clinical scenarios facing healthcare professionals managing osteoarthritis (OA) of the shoulder―Humeral Component Design During Primary Anatomic Total Shoulder Arthroplasty and Treatment for Shoulder OA with Intact Rotator Cuff and Severe Glenoid Retroversion.

OVERVIEW
The new AUC tools, which provide clinicians algorithms on how to optimally evaluate various conditions, stem from the consensus recommendations in the AAOS Clinical Practice Guideline on Management of Glenohumeral Joint OA. The target patient group is assumed to have:

• Attempted non-surgical treatment options as necessary/applicable
• An intact rotator cuff
• No neuromuscular condition that limits their ability to undergo arthroplasty
• Ability to comply with post-op prescriptions and restriction (post op care and rehab)
• No medical conditions that do not preclude surgery/general management (e.g., diabetes, late-stage renal disease)

Humeral Component Design
This AUC is intended for use as part of the management of patients with glenohumeral joint osteoarthritis. Conditions not covered by this AUC include inflammatory arthropathies; post-infectious process; and post-capsulorrhaphy arthropathy. Access the complete AUC here.

Treatment for Shoulder OA with Intact Rotator Cuff and Severe Glenoid Retroversion
This AUC is intended to offer guidance on decision factors for various treatments for shoulder osteoarthritis in adults with intact rotator cuff and severe glenoid retroversion. Conditions not covered in this AUC include inflammatory arthropathies; Type A1, A2, B1, and D Glenoids; post-traumatic OA; post-infectious process; and post-capsulorrhaphy arthropathy. Access the complete AUC here.

PREVELANCE
Simply defined, glenohumeral (shoulder) joint osteoarthritis is a common source of pain and disability that affects nearly one third of the world’s population over the age of 60.[i][ii][iii] As a result, chronic shoulder pain can result in reduced range of motion and limit activity, often causing interference with even the most common everyday tasks, such as dressing, reaching for objects, and even personal hygiene. The AUCs are timely as the disease burden of patients who may need treatment for glenohumeral joint osteoarthritis is increasing as the population ages.

INTENDED AUC USERS
The new AUCs are intended to be used by all qualified and appropriately trained providers and surgeons involved in treating patients with glenohumeral joint osteoarthritis; however, healthcare professionals other than orthopaedic surgeons, including but not limited to adult primary care physicians, adult medicine specialists, physical therapists, hand therapists, occupational therapists, physician assistants, social workers, case managers, psychologists, and nurse practitioners who routinely see this patient population in various practice settings may benefit from this tool. These new tools are not intended for use as a benefits determination document.

FOR MORE INFORMATION
Available through AAOS’ OrthoGuidelines website or free mobile app, the AUC tools offer accepted approaches to treatment and/or diagnosis and are not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s specific clinical circumstances. For more information on the development process for these tools, please reference the AUC Methodology or email media@aaos.org. 

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[i] Singh, J.A., Sperling, J., Buchbinder, R., McMaken, K., Surgery for shoulder osteoarthritis. Cochrane Database Syst Rev. 2010;10:CD008089.

[ii] Cho, C. H., Song, K. S., Hwang, I., Coats-Thomas, M. S., Warner, J. J. P. Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty. Journal of Bone & Joint Surgery - American Volume 2017; 12: 1030-1035.

[iii] Gartsman, G. M., Elkousy, H. A., Warnock, K. M., Edwards, T. B., O'Connor, D. P. Radiographic comparison of pegged and keeled glenoid components. Journal of Shoulder & Elbow Surgery 2005; 3: 252-7