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Robert T. Burks - One of the best experts on this subject based on the ideXlab platform.
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Commentary & Perspective Chondrolysis is Not Just a Shoulder Problem Anymore Commentary on an article by Frank R. Noyes, MD, et al.: ‘‘The Development of Postoperative Knee Chondrolysis After Intra-Articular Pain Pump Infusion of an Anesthetic Me
2016Co-Authors: Robert T. BurksAbstract:As orthopaedic surgeons in training, we were all taught about Chondrolysis as it relates to the pediatric hip1. Unfortunately, another type of Chondrolysis has surfaced in recent years with increased frequency. Most notably, this has been described in the shoulder2. Although exact trigger events have not been fully determined, the cases appear to be associated with primarily arthroscopic procedures, variable use of heat probe electrical devices, intra-articular pain pumps for postoperative pain control, prominent hardware, and infections1,2. The article by Noyes et al. brings to our attention a series of cases of Chondrolysis of the knee that were presumed to be due to intra-articular pain pump usage and constant infusion of bupivacaine over a minimum of forty-eight hours after a surgical procedure. The authors report on twenty-one patients with a mean age of twenty-three years. As has been reported in studies of Chondrolysis in the shoulder, this condition is unfortunately common in the young patient, who one would presume, for the most part, to have normal articular cartilage at the time of the index operation. In the series by Noyes et al., increasing pain developed primarily in the first year after the use of the pain pump, which again is similar to what has been reported in the shoulder. Interestingly, in the current study, the meniscus seemed to be relatively resistant to the effects of the bupivacaine, which were so devastating to the articular cartilage. We are currently going through a transformation in orthopaedic literature, and levels of evidence have become more front and center in the evaluation of a particular study’s importance. To that end, the study by Noyes et al. is only Level IV. Unfortunately
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Bilateral Shoulder Chondrolysis Following Arthroscopy A Report of Two Cases
2016Co-Authors: E. Greis, Er Legr, Robert T. BurksAbstract:houlder arthroscopy has become a common means of treating shoulder instability. Recent reports have docu-mented the rare but devastating complication of chon-drolysis following arthroscopic shoulder procedures1-4. Although the cause of Chondrolysis following these procedures remains unclear, an association with a number of variables has been suggested1-9. We present the cases of two individuals, each of whom presented to our institution for the evaluation and treatment of severe shoulder pain after having undergone bilateral ar-throscopic shoulder procedures at separate operative times at another institution. Each patient subsequently developed se-vere Chondrolysis of both shoulders. The demographic infor-mation, surgical records, and clinical course of the patients were reviewed in an attempt to identify factors associated wit
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Chondrolysis is not just a shoulder problem anymore: commentary on an article by Frank R. Noyes, MD, et al.: “The development of postoperative knee Chondrolysis after intra-articular pain pump infusion of an anesthetic medication. A series of twenty-
The Journal of bone and joint surgery. American volume, 2012Co-Authors: Robert T. BurksAbstract:As orthopaedic surgeons in training, we were all taught about Chondrolysis as it relates to the pediatric hip1. Unfortunately, another type of Chondrolysis has surfaced in recent years with increased frequency. Most notably, this has been described in the shoulder2. Although exact trigger events have not been fully determined, the cases appear to be associated with primarily arthroscopic procedures, variable use of heat probe electrical devices, intra-articular pain pumps for postoperative pain control, prominent hardware, and infections1,2. The article by Noyes et al. brings to our attention a series of cases of Chondrolysis of the knee that were presumed to be due to intra-articular pain pump usage and constant infusion of bupivacaine over a minimum of forty-eight hours after a surgical procedure. The authors report on twenty-one patients with a mean age of twenty-three years. As has been reported in studies of Chondrolysis in the shoulder, this condition is unfortunately common in the …
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Chondrolysis is not just a shoulder problem anymore commentary on an article by frank r noyes md et al the development of postoperative knee Chondrolysis after intra articular pain pump infusion of an anesthetic medication a series of twenty one case
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Robert T. BurksAbstract:As orthopaedic surgeons in training, we were all taught about Chondrolysis as it relates to the pediatric hip1. Unfortunately, another type of Chondrolysis has surfaced in recent years with increased frequency. Most notably, this has been described in the shoulder2. Although exact trigger events have not been fully determined, the cases appear to be associated with primarily arthroscopic procedures, variable use of heat probe electrical devices, intra-articular pain pumps for postoperative pain control, prominent hardware, and infections1,2. The article by Noyes et al. brings to our attention a series of cases of Chondrolysis of the knee that were presumed to be due to intra-articular pain pump usage and constant infusion of bupivacaine over a minimum of forty-eight hours after a surgical procedure. The authors report on twenty-one patients with a mean age of twenty-three years. As has been reported in studies of Chondrolysis in the shoulder, this condition is unfortunately common in the …
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Bilateral Shoulder Chondrolysis Following Arthroscopy. A Report of Two Cases
The Journal of bone and joint surgery. American volume, 2008Co-Authors: Patrick E. Greis, Alexander Legrand, Robert T. BurksAbstract:P.E. Greis and R.T. Burks reply: Drs. Levy and Frankle raise the issue of considering the differential diagnosis for Chondrolysis following shoulder arthroscopy. We agree that all causes of this problem must be considered when evaluating these patients. An indolent infection could certainly result in a poor long-term outcome of any further treatment if not recognized. Additionally, we agree that Chondrolysis may be multifactorial and that a complete understanding of this problem remains a work in progress requiring further investigation. However, there remains a very substantial and convincing body …
Frederick A Matsen - One of the best experts on this subject based on the ideXlab platform.
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published evidence demonstrating the causation of glenohumeral Chondrolysis by postoperative infusion of local anesthetic via a pain pump
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Frederick A Matsen, Anastasios PapadonikolakisAbstract:Background: Glenohumeral Chondrolysis is the irreversible destruction of previously normal articular cartilage, occurring most commonly after shoulder surgery in young individuals. The reported incidence of this complication has risen rapidly since the early 2000s. As Chondrolysis cannot be reversed, its occurrence can only be prevented by establishing and avoiding its causes. Methods: We analyzed all published cases of glenohumeral Chondrolysis, including the relevant published laboratory data, to consolidate the available evidence on the causation of this complication by the postoperative intra-articular infusion of local anesthetic via a pain pump. Results: Analysis of the published evidence demonstrated a causal relationship between the infusion of local anesthetic and the development of glenohumeral Chondrolysis. The risk of this complication in shoulders receiving intra-articular infusions via a pain pump was significantly greater with higher doses of local anesthetic: twenty of forty-eight shoulders receiving high-flow infusions developed Chondrolysis, whereas only two of twenty-five shoulders receiving low-flow infusions developed this complication (p = 0.0029). Eleven of twenty-two shoulders receiving 0.5% bupivacaine developed Chondrolysis, whereas none of six shoulders receiving 0.25% bupivacaine developed this complication (p = 0.05). Of twenty-two shoulders infused with 0.5% bupivacaine, the eleven that developed Chondrolysis had a mean pain pump delivery volume of 377 mL, whereas the eleven that did not develop Chondrolysis had a mean volume of 187 mL (p = 0.003). Among shoulders in which an intra-articular pain pump was used, the risk of Chondrolysis was significantly greater when suture anchors were placed in the glenoid for labral repair (p < 0.001). Conclusions: The published evidence indicates that the preponderance of cases of glenohumeral Chondrolysis can be prevented by the avoidance of the intra-articular infusion of local anesthetic via a pain pump. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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risk factors for Chondrolysis of the glenohumeral joint a study of three hundred and seventy five shoulder arthroscopic procedures in the practice of an individual community surgeon
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Brett P Wiater, Moni B Neradilek, Nayak L Polissar, Frederick A MatsenAbstract:Background: Glenohumeral Chondrolysis is a complication of arthroscopic shoulder surgery characterized by the dissolution of the articular cartilage of the glenoid and the humeral head. An analysis of 375 intra-articular shoulder arthroscopic surgical procedures by an individual community orthopaedic surgeon was performed to explore which factors or combinations of factors might be associated with glenohumeral Chondrolysis. Methods: The occurrence of Chondrolysis was correlated with several demographic and surgical variables with use of hazard ratios from Cox proportional hazards models and Kaplan-Meier survivorship curves. Sensitivity analysis was used to examine the effect of two different definitions of the date of the onset of Chondrolysis. Results: In this cohort, each case of documented Chondrolysis was associated with the intra-articular post-arthroscopic infusion of a local anesthetic, either Marcaine (bupivacaine) or lidocaine. In an analysis of the group that received an intra-articular postoperative infusion of a local anesthetic, the risk of Chondrolysis was found to be greater for those with one or more suture anchors placed in the glenoid, for younger patients, and for those who had the surgery near the end of the ten-year study period. Conclusions: To our knowledge, this is the first Level-II retrospective cohort study of the factors associated with the development of post-arthroscopic glenohumeral Chondrolysis. In this cohort of intra-articular shoulder arthroscopic procedures, Chondrolysis was observed only in cases in which either Marcaine or lidocaine had been infused into the joint during the postoperative period. Avoiding such a postoperative infusion may reduce the risk of Chondrolysis. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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Glenohumeral Chondrolysis: A systematic review of 100 cases from the English language literature
Journal of shoulder and elbow surgery, 2010Co-Authors: Peter T. Scheffel, Jeremiah Clinton, Joseph R. Lynch, Winston J. Warme, Alexander Bertelsen, Frederick A MatsenAbstract:Hypothesis Chondrolysis can be a devastating complication of shoulder arthroscopy. We undertook a review of the 100 cases reported in the English language to test the hypothesis that common factors could be identified and that the identification of these factors could suggest strategies for avoiding this complication. Materials and methods We systematically reviewed the English language literature and identified 16 articles reporting 100 shoulders in which postsurgical glenohumeral Chondrolysis had developed. Results The average reported patient age was 27 ± 11 years at the time of surgery; 35 were women. The most common indications for surgery were instability (n = 68) and superior labrum anteroposterior lesions (n = 17). In 59 cases, Chondrolysis was reported to be associated with the use of intra-articular pain pumps. The infusate was known to include bupivacaine in 50 shoulders and lidocaine in 2. Radiofrequency capsulorrhaphy was performed in 2 shoulders. Discussion Fifty-nine percent of the reported cases of glenohumeral Chondrolysis occurred with the combination of arthroscopic surgery and postarthroscopy infusion of local anesthetic. The arthroscopic operations observed with Chondrolysis were not limited to stabilization procedures, and the infused anesthetic was not limited to bupivacaine. Conclusion In that postoperative infusion of local anesthetic and radiofrequency may not be essential to the success of shoulder arthroscopy, surgeons may wish to consider the possible risks of their use.
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Postsurgical Chondrolysis of the shoulder.
Orthopedics, 2009Co-Authors: Matthew D. Saltzman, Alexander Bertelsen, Winston J. Warme, Deana M. Mercer, Frederick A MatsenAbstract:There are multiple reports in the literature of Chondrolysis following arthroscopic shoulder surgery. Although the etiology of these cases is not known for certain, there has been speculation that radiofrequency devices, young patient age, instability surgery, intra-articular pain pumps, and type of anesthetic may be precipitating factors. This article describes a case of a 37-year-old law enforcement officer who injured both shoulders and ultimately underwent nearly identical bilateral procedures: arthroscopic superior labrum anteroposterior (SLAP) repair, Bankart repair, capsulorrhaphy, acromioplasty, and distal clavicle excision. Intra-articular pain catheters were placed following both procedures, but the right-sided catheter never functioned properly, as evidenced by continuous leakage outside of her body until it was removed. Subsequently she had an arthroscopic lysis of adhesions done for residual stiffness, in which the left humeral head and glenoid cavity were noted to be completely devoid of articular cartilage. Over the ensuing months, multiple cortisone injections, 5 viscosupplementation injections, physical therapy, and narcotics all failed to relieve her left shoulder pain. Radiographs showed significant left glenohumeral joint space narrowing and a normal-appearing joint space on the right. Our impression was postsurgical Chondrolysis of the left shoulder. The patient has recently undergone humeral hemiarthroplasty with nonprosthetic glenoid arthroplasty. This case differs from others reported in the literature in that nearly identical bilateral procedures were performed by the same surgeon, yet Chondrolysis only developed on the side that had a functioning postoperative pain catheter.
Eb Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Chondrolysis in slipped upper femoral epiphysis. Long-term study of the aetiology and natural history
The Journal of bone and joint surgery. British volume, 1993Co-Authors: Bc Vrettos, Eb HoffmanAbstract:Of 44 patients (55 hips) with slipped upper femoral epiphysis treated from 1963 to 1989, 13 (14 hips) developed Chondrolysis. Eight hips had Chondrolysis at the time of presentation, all in female patients who were either coloured or black and who had moderate or severe slips. The other six hips had persistent pin penetration of the joint; in five of these the pin penetrated the anterosuperior quadrant of the head. Removal of penetrating pins resulted in improvement in pain in all six hips and in the range of movement in four. Chondrolysis did not develop in any of 11 hips with transient intraoperative pin penetration. In hips with Chondrolysis maximum joint-space narrowing developed within the first year; improvement in joint space and range of movement continued for up to three years after maximal involvement. At an average follow-up of 13.3 years no patient had pain but five hips were stiff.
Peter Giannoudis - One of the best experts on this subject based on the ideXlab platform.
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Screw placement in slipped upper femoral epiphysis: is good the enemy of better?
Journal of Children's Orthopaedics, 2007Co-Authors: Wiqqas Jamil, Mohamad K. Allami, Bobin Varghese, Mohammed Almaiyah, Peter GiannoudisAbstract:Introduction and aims A single hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours the placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes to avoid the risks of Chondrolysis and avascular necrosis (AVN). We investigated the correlation between different positions of the screw in the femoral head and the prevalence of AVN, Chondrolysis, late slippage and the time to epiphyseal closure. Methods The clinical notes and radiographs of 38 consecutive patients (61 hips) who underwent single screw fixation for SUFE were evaluated retrospectively with a mean follow-up of 36 months. Two-way ANOVA and the post hoc test was performed to analyse the correlation between the different variables and the outcome at the 5% level of significance. Results There were 16 acute slips, 18 chronic slips and ten acute-on-chronic slips. Seventeen slips were treated prophylactically. Mild slip was encountered in 39 hips, moderate slip in four and severe slip in one. The central–central position was only achieved in 51% of cases. The most significant results of the study were as follows: (1) no significant difference between the time to epiphyseal closure and the position of the screw, and (2) no late slippage or Chondrolysis was observed in our series. Conclusion Our results showed that the positioning of the screw other than in the centre of the femoral head has the ability to provide physeal stability and has no correlation with the timing to closure of the epiphysis and the risk of avascular necrosis or Chondrolysis. We therefore recommend that other positions be considered if the “optimal central–central position” is not initially achieved – specifically for the treatment of mild slip – as the potential hazards from several attempts to achieve the optimum position outweigh the benefits.
Richard S. Davidson - One of the best experts on this subject based on the ideXlab platform.
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Chondrolysis, osteonecrosis, and slip severity in patients with subsequent contralateral slipped capital femoral epiphysis.
The Journal of bone and joint surgery. American volume, 2008Co-Authors: Yakup Yildirim, Severino Bautista, Richard S. DavidsonAbstract:Background: Prophylactic pinning of the radiographically and clinically normal contralateral hip in a patient with a unilateral slipped capital femoral epiphysis remains controversial. The purpose of this study was to identify the prevalence of Chondrolysis and osteonecrosis and the degree of slip severity in contralateral hips with a subsequent slipped capital femoral epiphysis to determine whether the outcome or complications on the contralateral side were greater than the risks of prophylactic pinning. Methods: The medical records of the patients operated on between 1993 and 2003 at a single hospital for treatment of a slipped capital femoral epiphysis were retrospectively evaluated. The severity and the chronicity of the slips were graded. Only children who initially had had a unilateral slip and had been followed for a minimum of twenty-four months or until skeletal maturity were included in the analysis for detection of a subsequent contralateral slip. Patients with more than twelve months of follow-up were included in the analysis for detection of osteonecrosis and Chondrolysis. Results: Two hundred and twenty-seven patients had a unilateral slipped capital femoral epiphysis at the time of the primary admission. A subsequent slip developed in the contralateral hip of eighty-two children (36%) within a mean of 6.5 months. Eighteen of the contralateral slips were of moderate or severe severity, with a potential for a poor outcome due to a risk of osteoarthritis in the future. Osteonecrosis or Chondrolysis, each an established complication with a poor long-term prognosis, developed in five of the patients with a subsequent contralateral slip. Conclusions: The high prevalence of a subsequent contralateral slip (36%) and the potential complication (high slip severity) and established complications (osteonecrosis and Chondrolysis) related to the contralateral slip indicate that prophylactic pinning of the contralateral hip in a patient with a unilateral slipped capital femoral epiphysis is safer than and preferable to observation and symptomatic treatment. Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.