Osteo-arthritis of the joint implies that the cartilage surfaces of the joint have worn away. This leads to the bone of the ball being in direct contact with the bone of the socket. Arthritis of the joints seems to be increasing in the population as people are becoming older and more active. Conventional operations for arthritis have mostly been that of joint replacement where a metal ball is cemented to one side of the joint and a polyethylene (plastic) socket is cemented onto the other side of the joint.

The purpose is to appose two painless, smooth surfaces against each other. This is fairly large surgery and not without difficulties. Short term complications can be that of infection and dislocation of the implanted prosthetic joint. In the long run, the material in the replaced joint may wear out or the components may loosen.

One of the biggest dilemmas in dealing with this problem is when a relatively young patient suffers from arthritis of the joint. The artificial joints have a limited life time and when they wear out, loosen or get infected, the patient is often worse off than before the operation .Receiving a prosthesis into the joint implies that the patient should lead a less active lifestyle to try and preserve the joint for as long as possible. This is often difficult for younger and more active persons to accept.

Due to these concerns, many surgeons have been researching alternative, less invasive procedures for arthritic joints in the body and developments have certainly been encouraging in using metal resurfacing procedures not requiring removing the original bone and also biological options with cartilage transplant and stem cell therapy. Many of the latter treatment options for arthritis in the shoulder are not perfected yet, but a great deal of money and energy is being ploughed into it.

We have shared the concerns of the prosthetic joints in both the young and active older people and over the past 5 years the doctors at the Cape Shoulder Institute have been performing an arthroscopic operation (keyhole surgery) where a membrane is attached onto the surface of the socket allowing an ingrowth of cartilage- like tissue. This is a minor procedure compared to the standard open procedure and has had very promising results. When the insertion of the membrane is successful, it forms a layer of tissue on the surface preventing direct contact between the bony surfaces and thus removing the tenderness.

The great plus factor is that if and when it should fail, the patient is usually not worse off and a prosthesis can still be done as if it is a ?fresh? situation. We therefore regard such treatment as the first option in many shoulder arthritis cases.