Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty

Levy, Jonathan C.; Virani, Nazeem A.; Frankle, Mark A.; Cuff, Derek J.; Pupello, Derek; Hamelin, Jeff A.

doi:10.1016/j.jse.2007.11.004

Cited by 81 publications

(50 citation statements)

References 28 publications

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“…In the context of increasing demand for the difficult clinical problem of end-stage glenohumeral arthritis in younger patients, new techniques may be a promising area for further study. In some studies, TSA [24], humeral head resurfacing [30], and hemiarthroplasty with concentric glenoid reaming [31] in younger patients have shown promising short-and midterm results. We may see an additional increase in arthroplasty demand in younger patients with end-stage glenohumeral arthritis as arthroplasty options in this population improve.…”

Section: Discussionmentioning

confidence: 99%

Future Patient Demand for Shoulder Arthroplasty by Younger Patients: National Projections

Padegimas

Maltenfort

Lazarus

et al. 2015

Clinical Orthopaedics &Amp; Related Research

304

129

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Background The outcomes of shoulder arthroplasties in younger patients (55 years or younger) are not as reliable compared with those of the general population. Greater risk of revision and higher complication rates in younger patients present direct costs to the healthcare system and indirect costs to the patient in terms of quality of life. Previous studies have suggested an increased demand for shoulder arthroplasties overall, but to our knowledge, the demand in younger patients has not been explored.

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Section: Discussionmentioning

confidence: 99%

Future Patient Demand for Shoulder Arthroplasty by Younger Patients: National Projections

Padegimas

Maltenfort

Lazarus

et al. 2015

Clinical Orthopaedics &Amp; Related Research

304

129

View full text Add to dashboard Cite

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“…1,2,9 Careful attention to anchor insertion at the time of implantation is important. However, this does not necessarily guarantee that an anchor will not become proud during the course of postoperative treatment, although the natural history of metal, absorbable, and nonabsorbable implants in the glenoid is somewhat unknown.…”

Section: Discussionmentioning

confidence: 99%

“…6 Prominent glenohumeral anchors have been implicated in the early development of postoperative glenohumeral degenerative changes. 1,2,9 A proud implant may cause local wear on the glenoid and the humerus, contributing to chondral loss, decreased range of motion, mechanical symptoms, and pain.…”

mentioning

confidence: 99%

Postsurgical glenohumeral anchor arthropathy treated with a fresh distal tibia allograft to the glenoid and a fresh allograft to the humeral head

Provencher

LeClere

Ghodadra

et al. 2010

Journal of Shoulder and Elbow Surgery

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“…However, these studies did not evaluate buffering of the reagents to a physiologic pH and they were not performed on human cartilage. Also, there is heightened concern of potential chondrotoxicity of local anesthetics, with several case reports of patients having glenohumeral chondrolysis develop after placement of continuous intraarticular bupivacaine infusion [23,25,29,35]. Additionally, multiple in vitro studies suggest a cytotoxic effect of bupivacaine on articular chondrocytes [1,11,12,27,36].…”

Section: Introductionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Intraarticular injections of corticosteroids combined with local anesthetics are commonly used for management of chronic pain symptoms associated with degenerative joint diseases and after arthroscopic procedures. Several studies suggest chondrotoxicity of local anesthetics whereas others report chondroprotective and cytotoxic effects of corticosteroids on cartilage. Given the frequency of use of these agents, it is important to know whether they are in fact toxic. Questions/purposes We asked whether (1) bupivacaine and triamcinolone acetonide, alone and combined, were chondrotoxic to chondrocytes in culture; (2) buffering of the reagents diminished toxicity of the bupivacaine and triamcinolone; and (3) the presence of the superficial layer of articular cartilage protects against toxicity. Materials and Methods We obtained cartilage from three patients undergoing arthroplasty. To address triamcinolone acetonide, bupivacaine, and combinatorial toxicity to human chondrocytes, we set up monolayer chondrocyte cultures (n = 8 wells per condition). The question of buffering was addressed by performing the same assays as above, but the reagents were buffered. An MTT assay was used to assess chondrocyte survival in the monolayer. We harvested 21 articular plugs from each of three patients (total 63 plugs) and exposed them to the same reagents as above, including the buffered reagents. A Live/Dead assay was used to determine chondrocyte survival. Results Triamcinolone acetonide, bupivacaine, and their combination were toxic to human chondrocytes in the monolayer comparisons. The addition of buffering did not mitigate chondrocyte death. With the intact superficial layer in the plug group, bupivacaine was not toxic as compared with for the control group; all the other reagents (triamcinolone, combination bupivacaine/triamcinolone, buffered bupivacaine, buffered triamcinolone, and buffered combination) produced chondrotoxicity. Conclusions Triamcinolone induced chondrotoxicity in the articular plug and monolayer culture, whereas bupivacaine induced chondrotoxicity only in monolayer culture. The combined used of triamcinolone and bupivacaine did not show additive chondrocyte death in any arm. Buffering of bupivacaine increased its chondrotoxicity. Clinical Relevance Although not necessarily reflecting in vivo conditions, our data suggest physicians should be cognizant of the potential in vitro chondrotoxicity of bupivacaine and triamcinolone when contemplating intraarticular administration.

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Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty

Cited by 81 publications

References 28 publications

Future Patient Demand for Shoulder Arthroplasty by Younger Patients: National Projections

Future Patient Demand for Shoulder Arthroplasty by Younger Patients: National Projections

Postsurgical glenohumeral anchor arthropathy treated with a fresh distal tibia allograft to the glenoid and a fresh allograft to the humeral head

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

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