Prevalence of and Risk Factors for Dislocation Arthropathy

Abstract

At an average 13 years after arthroscopic Bankart repair, osteoarthritic changes are a common finding and, overall, are comparable with reports in the literature regarding open procedures as well as nonoperative treatment. The extent of trauma sustained during preoperative dislocations and the age of the patient seem to be more relevant for long-term dislocation arthropathy than the kind of treatment. Accordingly, the study hypothesis must be rejected. Avoiding preoperative dislocations is more important for the prevention of osteoarthritis than short-term treatment. The number of anchors used was found to be a predictor for long-term development of osteoarthritis.

Long Term Outcomes of Arthroscopic Shoulder Instability Surgery

“…Plath and colleagues [19] in a very recent publication, report on the clinical outcome as well as the rate of dislocation arthropathy in a rather large population of instability patients treated arthroscopically and followed for a minimum of 10 years (mean follow-up time: 13 years). They conclude that the overall clinical outcome was satisfactory, reporting a median Constant score of 94 and minimal external rotation deficit as compared to the contralateral shoulder.…”

“…No such evidence was available concerning the long term effect of arthroscopic anatomic procedures on the prevalence and evolution of dislocation arthropathy until recently, when a number of publications have demonstrated that the long-term incidence of moderate and severe dislocation arthropathy is similar to that reported following open anatomic procedures [18, 19, 28]. Furthermore, it has been suggested that glenohumeral chondrolysis can occur following arthroscopic surgery.…”

“…This has been mainly associated with post-arthroscopic infusion of the joint with local anaesthetic and secondarily with the extensive intra-operative use of radiofrequency for capsulorraphy [29]. The presence and grade of arthritic changes correlates with the number of dislocations sustained prior to the arthroscopic intervention and the age at initial dislocation and surgery [19]. Moreover, the number of anchors used, but not their type (metal, peek or bio-absorbable) was positively correlated with both the presence and severity of the degenerative changes recorded.…”

“…Moreover, the number of anchors used, but not their type (metal, peek or bio-absorbable) was positively correlated with both the presence and severity of the degenerative changes recorded. However, patients suffering a post-operative recurrence of instability did not have a higher frequency or grade of arthritic changes [19]. …”

“…Avoiding numerous pre-operative dislocations appears to prevent to some extent the occurrence and severity of post-operative dislocation arthropathy [19]. One should point out however that the clinical significance of radiologically evident dislocation arthropathy is debatable, as Constant score results do not seem to correlate with the presence or grade of postoperative dislocation arthropathy [8, 19]. …”