Clinical Orthopaedics and Related Research®

, Volume 468, Issue 9, pp 2545–2549

Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps

  • Okechukwu A. Anakwenze
  • Harish Hosalkar
  • G. Russell Huffman
Case Reports



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.


  1. 1.
    Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy. 2002;18:76–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Bojescul JA, Wilson G, Taylor DC. Idiopathic chondrolysis of the ankle. Arthroscopy. 2005;21:224–227.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    Coobs BR, LaPrade RF. Severe chondrolysis of the glenohumeral joint after shoulder thermal capsulorrhaphy. Am J Orthop. 2009;38:E34–E37.PubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Eisenstein A, Rothschild S. Biochemical abnormalities in patients with slipped capital femoral epiphysis and chondrolysis. J Bone Joint Surg Am. 1976;58:459–467.PubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF. Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy. 2007;23:797.e1-5.Google Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Hansen BP, Beck CL, Beck EP, Townsley RW. Postarthroscopic glenohumeral chondrolysis. Am J Sports Med. 2007;35:1628–1634.CrossRefPubMedGoogle Scholar
  14. 14.
    Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33:350–357.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.PubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Lubicky JP. Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:162–167.PubMedGoogle Scholar
  21. 21.
    Lubowitz JH, Poehling GG. Glenohumeral thermal capsulorrhaphy is not recommended: shoulder chondrolysis requires additional research. Arthroscopy. 2007;23:687.CrossRefPubMedGoogle Scholar
  22. 22.
    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.PubMedGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    Piper SL, Kim HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 2008;90:986–991.CrossRefPubMedGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar
  27. 27.
    van Huyssteen AL, Bracey DJ. Chlorhexidine and chondrolysis in the knee. J Bone Joint Surg Br. 1999;81:995–996.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: an end-result study. J Bone Joint Surg Am 1965;47:1128–1145.PubMedGoogle Scholar
  30. 30.
    Yarbrough R, Gross R. Chondrolysis: an update. J Pediatr Orthop. 2005;25:702–704.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Okechukwu A. Anakwenze
    • 1
  • Harish Hosalkar
    • 1
  • G. Russell Huffman
    • 1
  1. 1.Department of Orthopaedic SurgeryThe University of PennsylvaniaPhiladelphiaUSA

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