Arthroscopic surgery is a pretty standard procedure. In fact, over 600,000 arthroscopic surgeries are performed each year. Although every surgery comes with inherent risks, it has come as a huge surprise that some people have lost cartilage in their shoulder after undergoing such a routine surgical procedure. This cartilage loss is technically called postarthroscopic glenohumeral chondrolysis. In some cases it can result in the need for a complete shoulder replacement. Understanding what causes this condition is very important, and there has been some outstanding research done in the area.
One study worth mentioning is called, “Severe chondrolysis after shoulder arthroscopy: A case series “ by David S. Bailie, MDa, Todd S. Ellenbecker Volume 18, Issue 5, Pages 742-747 (September 2009). Here is an excerpt:” Hypothesis - Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications.
Materials and methods - Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, and potential etiological factors are reviewed. Management options are summarized. – Discussion - This case series identifies several common factors that could be responsible for post-arthroscopic glenohumeral chondrolysis. No single mechanism can be implicated based on the results of this study. Although strong concerns are raised over the use of intra-articular local anesthetics, glenohumeral chondrolysis appears to be an unfortunate convergence of multiple factors that may initiate rapid dissolution of articular cartilage and degenerative changes. Conclusion - Chondrolysis is a devastating complication of arthroscopic shoulder surgery that can result in long-term disabling consequences. Further research is required to specifically identify causative factors. Until this is a available, we strongly advise against the use of large doses of intra-articular placement of local anesthetics.”
Another good study is called, “Chondrolysis After Continuous Intra-Articular Bupivacaine Infusion: An Experimental Model Investigating Chondrotoxicity in the Rabbit Shoulder” by A. Gomoll, R. Kang, J. Williams, B. Bach, B. Cole - Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 22, Issue 8, Pages 813-819
Here is an excerpt: “Abstract - Purpose: Postoperative pain pumps are increasingly used to deliver a continuous infusion of local anesthetic into the surgical wound or the joint. Recently, there have been concerns that the use of such devices may be associated with chondrotoxicity and even cases of chondrolysis in the shoulder. An experimental model is presented that investigates potential chondrotoxic effects of a continuous intra-articular infusion of bupivacaine in the rabbit shoulder. Methods: We divided 30 rabbits into 3 groups that received continuous infusions of either saline solution, bupivacaine, or bupivacaine with epinephrine into the glenohumeral joint over a period of 48 hours. Animals were killed after 1 week, and osteochondral and synovial samples from the glenohumeral joint underwent analyses with confocal microscopy for live/dead cell assay, metabolic sulfate uptake assessment, and conventional histologic analysis. Results: Infusion of bupivacaine with epinephrine and without epinephrine decreased sulfate uptake by 56% (P = .009) and 50% (P = .02), respectively, when compared with saline solution; cell viability decreased by 20% (P = .08) and 32% (P = .02), respectively. Histologic analysis yielded significantly worse scores for bupivacaine infusion with epinephrine (P = .004) and without epinephrine (P = .02). The results for bupivacaine with or without epinephrine were not significantly different. Conclusions: Continuous intra-articular infusion of bupivacaine with and without epinephrine led to significant histopathologic and metabolic changes in articular cartilage. Clinical Relevance: Bupivacaine showed profound chondrotoxic effects in an experimental model that closely followed the current clinical application of postoperative pain pumps. The results caution against the use of such devices in applications for smaller joints with minimal clearance or dilution as a result of hematoma, where continuous exposure of cartilage to bupivacaine is expected.”
If you found either of these studies interesting, please read them in their entirety. This article should not be construed as medical advice.
Monty Wrobleski is the author of this article on Pain Pump Shoulder Surgery Lawsuit,Pain Pump Litigation
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