Glenohumeral chondrolysis is a rare and devastating complication of shoulder arthroscopy. No case reports of glenohumeral chondrolysis after routine shoulder arthroscopy appear in the literature. Three cases of rapid glenohumeral joint destruction following shoulder arthroscopy are described. CASE 1A 16-year-old male baseball and football player complained of pain in his right, dominant shoulder after 3 episodes of subluxation over the course of 2 years secondary to diving on the football and baseball fields. He was treated conservatively after each but failed to improve with 4 months of rehabilitation after the third subluxation. He underwent right shoulder arthroscopy in April 2001 at an outside institution for debridement of a posteroinferior labral tear. Figure 1 shows a preoperative radiograph of the affected shoulder. A radiofrequency ablator was used for this debridement. An extensive synovectomy and a coracoacromial ligament resection were also performed with the ablator followed by a modified subacromial decompression. His postoperative course was complicated by poor return of glenohumeral motion and mild to moderate pain with activities of daily living (ADLs). He was unable to return to sports.His glenohumeral joint was injected 4 months after the procedure with steroid and marcaine. He reported good immediate relief of pain following the injection with relief lasting for only 24 hours. Plain radiography was repeated at 5 months postoperative (Figure 2). It demonstrated significant glenohumeral space narrowing with early subchondral cyst formation in the glenoid. He presented to our clinic for the first time the following week. Range of motion (ROM) at that time was forward elevation to 180°, external rotation with elbow at the side to 60°and internal rotation to L4, and 1+ anterior laxity. Physical therapy was continued, focusing on maintaining glenohumeral ROM.A rheumatologic evaluation was also recommended. It was subsequently normal. He returned again to our clinic 8 months after his shoulder arthroscopy. He described a slow progression of pain in his right shoulder since his last visit, now with substantial pain during ADLs. Plain radiographs demonstrated progression of the glenohumeral joint space narrowing (Figure 3). An MRI demonstrated thinning of the glenohumeral articular surfaces and subchondral cyst formation in the glenoid and humerus. A repeat arthroscopy was performed as a diagnostic maneuver to rule out infection and to obtain a synovial biopsy. Arthroscopic findings were as follows: the glenoid was devoid of articular cartilage, and the exposed subchondral bone appeared friable (Figure 4). The humeral head was covered with smooth hyaline cartilage, but marginal osteophytes were present. The synovium was red with numerous villous projections throughout. The labrum was degenerative circumferentially, also with villous fibrillations throughout ( Figure 5). Operative cultures were negative for aerobes, anaerobes, acid-fast bacilli, and fungus. Biopsy of the synovium demonstrated numerous v...

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Male genital tract infections and non-specific inflammatory conditions may be associated with unexplained infertility. Previous studies have shown the presence of cytokines such as tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the semen of infertile men. However, the mechanism of effect of these cytokines on human sperm function is still controversial. The present study was undertaken to investigate the in-vitro effects of TNF-alpha and IFN-gamma on human sperm motion, viability and the hypoosmotic swelling test (HOST). Washed spermatozoa from normal volunteers (n = 9) were incubated in the presence/absence of TNF-alpha (1 microgram/mL) plus IFN-gamma (0.1 microgram/mL). Sperm motility, viability, HOST, and video sequences were recorded at different time intervals (0, 30, 60 and 180 min). Sperm motion parameters were analysed using computer-assisted semen analysis. There was a time-dependent negative effect of TNF-alpha plus IFN-gamma on sperm motility, viability, HOST, and lateral-head displacement (ALH). The maximum decrease was observed between 60 and 180 min for sperm motility (50.8 +/- 5.6%), viability (52.8 +/- 4.0%), HOST (38 +/- 2%) and ALH (4.7 +/- 0.1 microns) compared to control samples (62.2 +/- 2.8, 62.4 +/- 2.9, 58 +/- 4, and 5.3 +/- 0.4, respectively; All p < 0.05). There was no significant effect on sperm straight-line velocity and mean linearity when compared to control. These data suggest that the common inflammatory cytokines TNF-alpha plus IFN-gamma have only partial detrimental effects on sperm motility, viability, membrane integrity and lateral head displacement, which may contribute to the poor fertilizing potential of human spermatozoa during inflammatory conditions.

Pro-inflammatory cytokines are elevated in the semen of patients with genitourinary inflammation (GUI). Whether this increase in cytokines in GUI patients plays any critical role in male factor infertility is not clear. The present study investigated the in vitro effects of two important pro-inflammatory cytokines, lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma), on sperm motility, viability, membrane integrity and motion parameters. Washed spermatozoa from healthy donors were incubated with LPS (0.1 mg/mL) or IFN-gamma (0.1 mg/mL) alone or in combination. Sperm motility, viability, membrane integrity and computer-assisted motion were evaluated at various time intervals (0, 30, 60 and 180 min) after treatment. Sperm membrane integrity was analysed using the hypo-osmotic swelling test (HOST). LPS and IFN-gamma individually did not alter sperm viability or motility, but their combination showed a significant time-dependent decrease (p < 0.05) in sperm motility, viability and membrane integrity. Sperm motion parameters (straight-line velocity, curvilinear velocity, mean linearity, or amplitude of lateral head displacement) were not affected by LPS or IFN-gamma at the concentrations used in this study. These data suggest that the combination of LPS and IFN-gamma is detrimental to human spermatozoa and may contribute to male factor infertility in patients with chronic GUI.

Hemiresurfacing of the femoral head for treatment of osteonecrosis has been proposed as a reasonable alternative to total hip arthroplasty. The results of 59 patients with Ficat Stage III osteonecrosis done by a single surgeon are reviewed. At an average followup of 4.5 years, 16 patients were considered failures because of conversion to total hip arthroplasty or considerable groin pain requiring medication. Failure did not correlate with age, body mass index, preoperative length of symptoms, acetabular articular cartilage status at the time of surgery, or cause of the underlying disease. The only factor associated with failure was a lower preoperative Harris hip score. Conversion of the failed implants to total hip arthroplasty was straightforward, confirming the conservative nature of the procedure. However, pain relief and recovery after resurfacing are less reliable than that associated with total hip arthroplasty. This procedure may be appropriate for patients younger than 30 years, given the ease of conversion to THR if failure occurs. The patient should be counseled regarding expectations.