Purpose
The objective of this 2-part study is to report on the etiology, clinical findings,
and predictors of disease progression (part I) and the results of treatment (part
II) in a group of patients with glenohumeral chondrolysis.
Methods
Forty patients presented with glenohumeral chondrolysis after treatment elsewhere.
Twenty patients have been followed up since their initial presentation before arthroplasty
(group 1), and 20 patients were referred either for management of complications arising
after prosthetic arthroplasty or for evaluation only (group 2).
Results
Thirty-seven patients received an intra-articular pain pump (IAPP) delivering bupivacaine,
and 3 patients had prominent suture anchors or tacks. Symptoms related to chondrolysis
developed in patients at a mean of 9.8 months (range, 1 to 34 months) after the index
procedure. Radiographs showed joint space obliteration in 30 of 40 patients at most
recent follow-up or before arthroplasty. Of the patients receiving an IAPP delivering
bupivacaine, the majority received 0.5% with epinephrine. Higher bupivacaine dose
(P < .05) and female gender (P < .05) were associated with a longer interval to onset of symptoms. In addition,
a shorter interval to onset of symptoms predicted the need for subsequent surgery
(P < .05) and a shorter interval to second-look arthroscopy (P < .001).
Conclusions
Post-arthroscopic glenohumeral chondrolysis is a devastating and rapidly evolving
condition that most often strikes young patients. The use of IAPPs delivering local
anesthetics should be abandoned because nearly all cases of glenohumeral chondrolysis
in this series were associated with their use.
Level of Evidence
Level IV, therapeutic case series.
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Article Info
Publication History
Accepted:
April 12,
2013
Received:
September 22,
2011
Footnotes
The senior author has received remuneration for expert testimony on behalf of plaintiffs in pain pump litigation that did not relate to physician liability.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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