Advertisement

Arthroscopically Assisted Shoulder Arthrodesis: Is It an Effective Technique?

      Purpose

      The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open arthroscopic arthrodesis.

      Methods

      Twelve patients underwent arthroscopically assisted glenohumeral arthrodesis over a 5-year period; none were lost to follow-up. Surgery was performed with the patient in the lateral decubitus position, with the arm positioned in 30° each of flexion, internal rotation, and abduction. The articular cartilage was arthroscopically removed from the humerus and glenoid, creating flat opposing surfaces. One to 2 Kirschner wires were inserted percutaneously through the deltoid and across the glenohumeral joint in the center of the articulation; screws were then inserted arthroscopically. The glenohumeral joint was accessed through a mini-open posterior approach beneath the deltoid and was then reassessed before cannulated screws were tightened completely to compress the joint. Two dynamic compression plates were applied to the posterior glenohumeral joint to neutralize rotatory forces. Each patient was immobilized for 6 weeks. Follow-up radiographic imaging was performed at 2, 6, 12, and 24 months after surgery. These patients were then compared with a similar group who underwent a classic open approach. Success of arthrodesis was determined by bone growth across the glenohumeral joint as visualized on axillary radiographs.

      Results

      At 2-year follow-up, complete fusion was achieved in 12 (100%) arthroscopically treated patients, with 2 patients (17%) having early bone grafting (within 6 weeks) through a percutaneous approach. Four patients in the classic open approach group (“open group”) required additional grafting. Two patients in the group undergoing arthroscopic surgery (“arthroscopic group”) had solid fusion but persisting infection from previously failed operations. Comparison of the 2 groups showed no difference in patient satisfaction or infection rates (2 in each group, all of whom had active infection at the time of the index surgery). One patient in the open group sustained a humeral shaft fracture 5 years after arthrodesis, which required additional surgery. No patient who underwent an arthroscopic procedure required additional surgery other than the 2 early bone grafts.

      Conclusions

      Arthroscopically assisted mini-open glenohumeral arthrodesis provides results that are at least equal to those of open arthrodesis, with a much less invasive approach. Success and complication rates are the same as for the completely open procedure.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Diaz J.A.
        • Cohen S.B.
        • Warren R.F.
        • Craig E.V.
        • Allen A.A.
        Arthrodesis as a salvage procedure for recurrent instability of the shoulder.
        J Shoulder Elbow Surg. 2003; 12: 237-241
        • Rowe C.R.
        Arthrodesis of the shoulder used in treating painful conditions.
        Clin Orthop Relat Res. 1983; 173: 92-96
        • Clare D.J.
        • Wirth M.A.
        • Groh G.I.
        • Rockwood Jr., C.A.
        Shoulder arthrodesis.
        J Bone Joint Surg Am. 2001; 83: 593-600
        • Charnley J.
        Compression arthrodesis of the ankle and shoulder.
        J Bone Joint Surg Br. 1951; 33B: 180-191
        • Cofield R.H.
        Shoulder arthrodesis and resection arthroplasty.
        Instr Course Lect. 1985; 34: 268-277
        • Scalise J.J.
        • Iannotti J.P.
        Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty.
        J Bone Joint Surg Am. 2008; 90: 70-77
        • Morgan C.D.
        • Casscells C.D.
        Arthroscopic-assisted glenohumeral arthrodesis.
        Arthroscopy. 1992; 8: 262-266
        • Richards R.R.
        • Sherman R.M.
        • Hudson A.R.
        • Waddell J.P.
        Shoulder arthrodesis using a pelvic-reconstruction plate. A report of eleven cases.
        J Bone Joint Surg Am. 1988; 70: 416-421
        • Klonz A.
        • Habermeyer P.
        [Arthrodesis of the shoulder. A new and soft-tissue-sparing technique with a deep locking plate in the supraspinatus fossa].
        Unfallchirurg. 2007; 110 ([in German]): 891-895
        • Syal A.
        • MacDonald P.
        Arthroscopic arthrodesis of the shoulder: A report of two cases.
        J Shoulder Elbow Surg. 2008; 17: e23-e25
        • Hiersemann K.
        • Patsalis T.
        • Saxler G.
        [Arthroscopy-assisted glenohumeral arthrodesis: A case of uncontrollable shoulder instability].
        Unfallchirurg. 2007; 110 ([in German]): 456-459
        • Roach K.E.
        • Budiman-Mak E.
        • Songsiridej N.
        • Lertratanakul Y.
        Development of a shoulder pain and disability index.
        Arthritis Care Res. 1991; 4: 143-149
        • Marchese C.
        • Cristalli G.
        • Pichi B.
        • et al.
        Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dysfunction after neck dissection: University of California - Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Disability Index (SPADI) and Simple Shoulder Test (SST).
        Acta Otorhinolaryngol Ital. 2012; 32: 12-17
        • Lerch S.
        • Berndt T.
        • Lipka W.
        • Rühmann O.
        [Screw arthrodesis of the shoulder].
        Oper Orthop Traumatol. 2011; 23 ([in German]): 215-226
        • Dimmen S.
        • Madsen J.E.
        Long-term outcome of shoulder arthrodesis performed with plate fixation: 18 patients examined after 3-15 years.
        Acta Orthop. 2007; 78: 827-833
        • Beltran J.E.
        • Trilla J.C.
        • Barjau R.
        A simplified compression arthrodesis of the shoulder.
        J Bone Joint Surg Am. 1975; 57: 538-541
        • Rowe C.R.
        Re-evaluation of the position of the arm in arthrodesis of the shoulder in the adult.
        J Bone Joint Surg Am. 1974; 56: 913-922
        • Groh G.I.
        • Williams G.R.
        • Jarman R.N.
        • Rockwood Jr., C.A.
        Treatment of complications of shoulder arthrodesis.
        J Bone Joint Surg Am. 1997; 79: 881-887
        • Denard P.J.
        • Wirth M.A.
        • Orfaly R.M.
        Management of glenohumeral arthritis in the young adult.
        J Bone Joint Surg Am. 2011; 93: 885-892
        • Jiménez-Martín A.
        • Pérez-Hidalgo S.
        Arthroscopic arthrodesis of the shoulder: Fourteen-year follow-up.
        Int J Shoulder Surg. 2011; 5: 54-59
        • Endo H.
        • Takigawa H.
        • Takata K.
        • Miyoshi S.
        Loose shoulder: Diagnosis and treatment. [Translated by Eiji Itoi, MD, PhD from the original paper in Japanese published in Central Jpn J Orthop Surg Traumatol 1971;14:630-632].
        J Shoulder Elbow Surg. 2012; 21: 1782-1784
        • Hirakawa M.
        On the etiology of the loose shoulder—Biochemical studies on collagen from joint capsules.
        Nihon Seikeigeka Gakkai Zasshi. 1991; 65: 550-560
        • Forsythe B.
        • Ghodadra N.
        • Romeo A.A.
        • Provencher M.T.
        Management of the failed posterior/multidirectional instability patient.
        Sports Med Arthrosc. 2010; 18: 149-161
        • Voigt C.
        • Schulz A.P.
        • Lill H.
        Arthroscopic treatment of multidirectional glenohumeral instability in young overhead athletes.
        Open Orthop J. 2009; 3: 107-114
        • Mohtadi N.G.
        • Hollinshead R.M.
        • Ceponis P.J.
        • Chan D.S.
        • Fick G.H.
        A multi-centre randomized controlled trial comparing electrothermal arthroscopic capsulorrhaphy versus open inferior capsular shift for patients with shoulder instability: Protocol implementation and interim performance: Lessons learned from conducting a multi-centre RCT [ISRCTN68224911; NCT00251160].
        Trials. 2006; 7: 4
        • Warth R.J.
        • Briggs K.K.
        • Dornan G.J.
        • Horan M.P.
        • Millett P.J.
        Patient expectations before arthroscopic shoulder surgery: Correlation with patients' reasons for seeking treatment.
        J Shoulder Elbow Surg. 2013; 22: 1676-1681
        • Chaudhury S.
        • Gasinu S.
        • Rodeo S.A.
        Bilateral anterior and posterior glenohumeral stabilization using Achilles tendon allograft augmentation in a patient with Ehlers-Danlos syndrome.
        J Shoulder Elbow Surg. 2012; 21: e1-e5