Abstract
Background
Acute idiopathic chondrolysis in young adults is rare. The etiology often is unknown and outcomes can be devastating owing to rapid development of painful secondary osteoarthritis. There have been some recent reports of chondrolysis after arthroscopic shoulder procedures. Animal and laboratory data suggest chondrolysis is related to the use of intraarticular pain pumps, although there is no conclusive evidence that this is causative in patients.
Case description
We present two cases of young adults with chondrolysis of the humeral head after intraarticular pain pump use with humeral head resurfacing and biologic glenoid resurfacing.
Literature review
Several authors report glenohumeral chondrolysis after shoulder arthroscopy involving the use of bupivacaine pain pumps. In addition, experimental animal studies have confirmed the presence of chondrolysis after bupivacaine infusion.
Purposes and clinical relevance
These cases provide additional evidence of an important association between postarthroscopic chondrolysis of the glenohumeral joint and the use of bupivacaine pain pumps.
References
Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy. 2002;18:76–81.
Bojescul JA, Wilson G, Taylor DC. Idiopathic chondrolysis of the ankle. Arthroscopy. 2005;21:224–227.
Busfield BT, Lee GH, Carrillo M, Ortega R, Kharrazi FD. Subacromial pain pump use with arthroscopic shoulder surgery: a short-term prospective study of complications in 583 patients. J Shoulder Elbow Surg. 2008;17:860–862.
Chu CR, Izzo NJ, Papas NE, Fu FH. In vitro exposure to 0.5% bupivacaine is cytotoxic to bovine articular chondrocytes. Arthroscopy. 2006;22:693–699.
Coobs BR, LaPrade RF. Severe chondrolysis of the glenohumeral joint after shoulder thermal capsulorrhaphy. Am J Orthop. 2009;38:E34–E37.
Douw CM, Bulstra SK, Vandenbroucke J, Geesink RG, Vermeulen A. Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy: case reports and review of the literature. J Bone Joint Surg Br. 1998;80:437–440.
Eisenstein A, Rothschild S. Biochemical abnormalities in patients with slipped capital femoral epiphysis and chondrolysis. J Bone Joint Surg Am. 1976;58:459–467.
Elhassan B, Ozbaydar M, Diller D, Higgins LD, Warner JJ. Soft-tissue resurfacing of the glenoid in the treatment of glenohumeral arthritis in active patients less than fifty years old. J Bone Joint Surg Am 2009;91:419–424.
Gomoll AH, Kang RW, Williams JM, Bach BR, Cole BJ. Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotoxicity in the rabbit shoulder. Arthroscopy. 2006;22:813–819.
Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Williams JM, Bach BR, Cole BJ. Long-term effects of bupivacaine on cartilage in a rabbit shoulder model. Am J Sports Med. 2009;37:72–77.
Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF. Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy. 2007;23:797.e1-5.
Greis PE, Legrand A, Burks RT. Bilateral shoulder chondrolysis following arthroscopy: a report of two cases. J Bone Joint Surg Am. 2008;90:1338–1344.
Hansen BP, Beck CL, Beck EP, Townsley RW. Postarthroscopic glenohumeral chondrolysis. Am J Sports Med. 2007;35:1628–1634.
Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33:350–357.
Ishida K, Kuroda R, Sakai H, Doita M, Kurosaka M, Yoshiya S. Rapid chondrolysis after arthroscopic partial lateral meniscectomy in athletes: a case report. Knee Surg Sports Traumatol Arthrosc. 2006;14:1266–1269.
Krishnan SG, Reineck JR, Nowinski RJ, Harrison D, Burkhead WZ. Humeral hemiarthroplasty with biologic resurfacing of the glenoid for glenohumeral arthritis: surgical technique. J Bone Joint Surg Am 2008;90(suppl 2, pt 1):9–19.
Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006;36:138–151.
Levine WN, Clark AM Jr, D’Alessandro DF, Yamaguchi K. Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability: a report of two cases. J Bone Joint Surg Am 2005;87:616–621.
Lowe HG. Necrosis of articular cartilage after slipping of the capital femoral epiphysis: report of six cases with recovery. J Bone Joint Surg Br. 1970;52:108–118.
Lubicky JP. Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:162–167.
Lubowitz JH, Poehling GG. Glenohumeral thermal capsulorrhaphy is not recommended: shoulder chondrolysis requires additional research. Arthroscopy. 2007;23:687.
Nakagawa Y, Ueo T, Miki T, Kotani H, Onishi E, Nakamura T. Glenohumeral osteoarthritis following a “color test” during rotator cuff repair: a case report and a review of the literature. Bull Hosp Jt Dis. 1998;57:216–218.
Park JY, Lee GW, Kim Y, Yoo MJ. The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med. 2002;27:145–149.
Petty DH, Jazrawi LM, Estrada LS, Andrews JR. Glenohumeral chondrolysis after shoulder arthroscopy: case reports and review of the literature. Am J Sports Med. 2004;32:509–515.
Piper SL, Kim HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 2008;90:986–991.
Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA II. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy. 2000;16:339–342.
van Huyssteen AL, Bracey DJ. Chlorhexidine and chondrolysis in the knee. J Bone Joint Surg Br. 1999;81:995–996.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection. Med Care. 1992;30:473–483.
Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: an end-result study. J Bone Joint Surg Am 1965;47:1128–1145.
Yarbrough R, Gross R. Chondrolysis: an update. J Pediatr Orthop. 2005;25:702–704.
Acknowledgments
We thank Norma Rendon BS, for help with the manuscript.
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Anakwenze, O.A., Hosalkar, H. & Huffman, G.R. Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps. Clin Orthop Relat Res 468, 2545–2549 (2010). https://doi.org/10.1007/s11999-010-1244-5
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DOI: https://doi.org/10.1007/s11999-010-1244-5