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

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.

The In Vitro Chondrotoxicity of Single-Dose Local Anesthetics

“…Continuous administration of local anesthetics into human and animal joints has been linked to subsequent chondrolysis. 1,2,4,17,20,28,32 Several studies have examined the detrimental effects of local anesthetics using in vivo models, 10,17 while others have documented the chondrotoxic effects of lidocaine, 19,26,27,36 bupivacaine, 3,11,12,22,27,31 and ropivacaine 27 using in vitro models. Some investigators have found the chondrotoxic effect of local anesthetics to be less conclusive.…”

Comparison of intraarticular bupivacaine and levobupivacaine injection in rat synovial inflammation

“…Anakwenze et al (22) reported 2 cases where young patients had glenohumeral chondrolysis, which developed after treatment with bupivacaine intraarticular pain pumps. Studies on the effects of bupivacaine in the joint have shown that the consequences of intraarticular usage differ depending on the model used.…”

Bupivacaine decreases cell viability and matrix protein synthesis in an intervertebral disc organ model system

“…, all of which require further careful and systematic investigation. Nevertheless, bupivacaine cytotoxicity uncovered from this and other studies suggest that caution should be taken, especially in the cases of continuous infusion by using the so called pain pumps which are currently being developed for therapeutic treatment of low back pain and joint pain [20, 29, 30]. …”

“…Other studies report intra-articular bupivacaine results in histopathologic change and chondrotoxic effects in rabbit joints [11–13]. Also emerging is an increasing number of case reports of patients experiencing complete chondrolysis of the shoulder and knee after bupivocaine infusions [20, 29]. Recently bupivacaine was also reported to decrease viability of rabbit and human disc cells to an even greater extent than that observed with articular chondrocytes [14].…”