Chondrolysis of the Glenohumeral Joint (SS-23)

Abstract

Chondrolysis has become a recognized complication of arthroscopic procedures. We present 18 patients who developed chondrolysis of the glenohumeral joint following arthroscopic shoulder surgery. All 18 patients had a labral stabilization procedure and received an intra-articular pain pump catheter (IAPPC) for post-operative pain control. The IAPPC's were loaded with 0.5% bupivacaine with epinephrine to provide a continuous infusion of local anaesthetic into the joint. We suspect the continuous infusion of bupivacaine may have contributed to the development of chondrolysis. We caution against the use of IAPPC's until their safety has been proven. Two orthopaedic surgeons identified 18 patients who developed glenohumeral chondrolysis following arthroscopic shoulder surgery. The index surgery for all 18 patients occurred over an 18 month period. We sought to find any common factors among the 18 cases. A retrospective chart review of all 18 patients was performed. We gathered information on patient demographics, type of surgical procedure, nature of shoulder instability, post-operative complications such as infection, the use of radiofrequency energy, the type/number of suture anchors, the use of an IAPPC and the type of local anaesthetic used. We compared pre-operative radiographs and MRI scans to the intra-operative findings from the operative report to confirm that no chondrolysis was present pre-operatively. We examined post-operative radiographs and MRI scans to document the extent of chondrolysis. Of the 18 patients who developed chondrolysis, we had 15 males and 3 females with an average age of 23 years (range 16-39). 17 patients had shoulder instability due to a definitive traumatic event while 1 patient had an atraumatic etiology. No radiofrequency energy was used in any of the cases. No post-operative infections were diagnosed and many had work-ups for infection which included ESR, CRP, bone & gallium/WBC scans. All patients had labral stabilization procedures, 15 anterior (Bankart), 1 posterior, and 2 combinations. All patients received suture anchors, 13 patients had 2 anchors and 5 had 3 anchors. 2 different manufacturer's suture anchors were used, 10 patients received Smith & Nephew anchors while 8 patients received Linvatec anchors. 10 patients received bioabsorbable anchors and 8 patients received metal anchors. All patients received an IAPPC loaded with 0.5% bupivacaine with epinephrine for post-operative pain control. 15 of the IAPPC's were considered large with an infusion rate of 5 mL/hr and a fill volume of 275 mL. 3 IAPPC's were considered small with an infusion rate of 2 mL/hr and a fill volume of 100 mL. We suspect a continuous intra-articular infusion of bupivacaine with epinephrine may have contributed to the development of glenohumeral chondrolysis. We caution against the use of IAPPC's until their safety has been proven.