2009 Annual Meeting Podium Presentations

Shoulder 5: Rotator Cuff/ Reverse Shoulder Arthroplasty

Characteristics of chondrolysis associated with intra-articular pain-pumps after shoulder surgery.

Podium No: 563

Friday, February 27, 2009
02:24 PM - 02:30 PM

Location: Venetian Hotel
Venetian Ballroom I

Peter Thomas Scheffel, MD Seattle WA
Jeremiah Clinton, MD Jackson WY
Joseph Lynch, MD Port Orchard WA
Winston J Warme, MD Bellevue WA
Frederick A Matsen III, MD Seattle WA

Moderator(s):
Carl J Basamania, MD Seattle WA
Guido Marra, MD Maywood IL

Chondrolysis associated with the use of pain-pumps after shoulder arthroscopy is characterized by the complete loss of articular cartilage from the humeral head and glenoid. Surgeons and patients need to be aware of this potential complication of the infusion of local anesthetic after shoulder arthroscopy.

Chondrolysis after shoulder arthroscopy has been noted in association with radiofrequency and laser devices within the joint, with intraarticular injection of dye, and with the post-arthroscopy infusion of local anesthetic into the joint.

We identified 66 cases of chondrolysis associated with shoulder arthroscopy followed by the intra-articular infusion of local anesthetic: 41 right shoulders and 25 left shoulders in 23 females and 41 males with an average age of 32.4 years (15-57) from the practices of multiple surgeons. The index surgeries were straightforward arthroscopies, including 28 capsular stabilizations, 18 Bankart repairs, 27 SLAP repairs, 7 rotator cuff repairs, 2 capsular repairs, 2 debridements, and 1 capsular release. In 55 patients the joint surfaces were normal at the time of arthroscopy. Radiofrequency capsulorrhaphy was used in 6 of the cases. In two thirds of the cases the infusate contained Bupivacaine and in one third Lidocaine was used. Epinephrine was used in over half of the cases. The infusion rates ranged from 2 to 5 cc/hr.

The patients demonstrated pain and loss of motion. Radiographic documentation of chondrolysis was established at an average of 707 days (91 to 1650) after the arthroscopic procedure.

X-ray and MRI changes were consistent: joint space narrowing, marginal erosions, subchondral cysts of the glenoid and humeral head, periarticular osteopenia, bone edema, and minimal osteophytosis. At the time of our review, 29 patients had non-arthroplasty revision surgery at an average of 311 days after arthroscopy; 26 had prosthetic arthroplasties at an average of 936 days. One patient had a spontaneous arthrodesis.

At revision surgery the characteristic findings included minimal synovitis, severe loss of glenoid and humeral articular cartilage, subchondral cysts, central glenoid erosion and minimal osteophytosis.

Chondrolysis is a devastating complication that can be associated with arthroscopic surgery and post-arthroscopy infusion of local anesthetic in young individuals of either gender having surgery for instability, SLAP lesions and rotator cuff disorders. In contrast to previous reports, the arthroscopic operations in this series were not limited to stabilization procedures and were not limited to cases in which bupivacaine was used.

The pathological findings on radiographs and at surgery were not that of primary degenerative joint disease, but rather more similar to the erosive arthritis seen with autoimmune conditions, such as rheumatoid arthritis and lupus.

A ^· to the left of the title indicates the FDA has not cleared the drug or device for the described purpose.

An alphabetical listing of disclosures will be available at a later time.

Return to Podium Presentations | Return to Friday Presentations