Elsevier

Journal of Shoulder and Elbow Surgery

Volume 18, Issue 5, September–October 2009, Pages 742-747
Journal of Shoulder and Elbow Surgery

Shoulder
Severe chondrolysis after shoulder arthroscopy: A case series

https://doi.org/10.1016/j.jse.2008.10.017Get rights and content

Hypothesis

Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications.

Materials and methods

Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, and potential etiological factors are reviewed. Management options are summarized.

Results

Of the 23 cases of chondrolysis identified in our practice over a two year period, 14 occurred in patients following labral repair using a bioabsorbable device. Seventeen of the 23 patients used a high volume intra-articular pain pump for 48 hours after surgery. Seven of the 23 cases had documented use of a thermal probe. Four cases occurred in shoulders with no reported use of fixation anchors, pain pumps, or thermal probes. All cases had at least a 20 cc intra-articular bolus injection of 0.25% bupivicaine with epinephrine.

Discussion

This case series identifies several common factors that could be responsible for post-arthroscopic glenohumeral chondrolysis. No single mechanism can be implicated based on the results of this study. Although strong concerns are raised over the use of intra-articular local anesthetics, glenohumeral chondrolysis appears to be an unfortunate convergence of multiple factors that may initiate rapid dissolution of articular cartilage and degenerative changes.

Conclusion

Chondrolysis is a devastating complication of arthroscopic shoulder surgery that can result in long-term disabling consequences. Further research is required to specifically identify causative factors. Until this is a available, we strongly advise against the use of large doses of intra-articular placement of local anesthetics.

Level of evidence

Level 4; Case series, no control group.

Section snippets

Materials and methods

We reviewed the records of suspected cases of glenohumeral chondrolysis that presented to our office after shoulder arthroscopy from 2005 to 2006. This research study was submitted to and approved by the Institutional Review Board of Physiotherapy Associates (Exton, PA) before the review of patient data. This time period was used because we had not been aware of a single case of glenohumeral chondrolysis in our clinic before 2005. A total of 23 cases were identified. Chondrolysis was suspected

Results

There were 23 documented cases of chondrolysis of the glenohumeral joint. The details are summarized in Table I. The mean age was 30.5 years (range, 15-47 years). The onset of symptoms occurred at a mean of 9.1 months after the index operation (range, 8-12 months). No patient indicated an intervening injury during the time from index surgery to presentation to our office. Review of all available preoperative and intraoperative data failed to show any evidence of degenerative arthritis,

Discussion

Given the total number of shoulder arthroscopies done each year, the occurrence of chondrolysis still appears to be rare. Of the 3 commonly used modalities implicated by various authors as potential contributors to chondrolysis (pain pumps, thermal devices, and bioabsorbable tissue anchors), devices used for tissue shrinkage initially had the greatest research support as a potential cause for chondrolysis.8, 12, 24 The association for both pain pumps and bioabsorbable anchors was initially more

References (25)

  • D. Chao et al.

    Postoperative pain management for arthroscopic shoulder surgery: interscalene block versus patient-controlled infusion of 0.25% bupivicaine

    Am J Orthop

    (2006)
  • D.J. Daluga et al.

    Idiopathic chondrolysis of the hip

    J Pediatr Orthop

    (1989)
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