Dislocation Arthropathy of the Shoulder

Abstract

Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient's age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.

Keywords: arthroplasty; dislocation arthropathy; glenohumeral osteoarthrosis; shoulder dislocation; shoulder instability.

Figure 1

Imaging methods for evaluating dislocation arthropathy. Examples of conventional radiographs, MRI, and CT scan showing OA.

Figure 2

Image modified from Buscayret et al. [15]. (a): humeral osteophyte <3 mm. (b): humeral osteophyte >3 mm and <8 mm. (c): humeral osteophyte >8 mm. (d): obliteration of glenohumeral joint space.

Figure 3

Details of proud screws after glenoid fracture surgery removed arthroscopically. First row: radiologic studies showing instability surgery performed and proud implants. Second row: Images of a humeral cartilage defect and debridement necessary to expose implants. Third row: Arthroscopic screws removal.

Figure 4

43 year-old patient treated with hemiprosthesis after capsulorrhaphy arthropathy subsequent to open instability repair. First row: preoperative radiographs. Second row: intraoperative pictures of hemiprosthesis implant and postoperative radiographs. Third row: Physical examination and shoulder function at final follow-up.

Figure 5

22-year-old patient with dislocation arthropathy after instability surgery treated with stemless prosthesis. First row: radiographs showing OA after shoulder instability surgery. Second row: intraoperative pictures of hemiprosthesis. Third row: Physical examination and shoulder function at final follow-up.

Figure 6

61-year-old male with bilateral dislocation arthropathy. (A): right shoulder dislocation arthropathy after instability surgery. (B): left shoulder dislocation arthropathy after instability surgery. (C): treatment with bilateral two surgeries Reverse Shoulder Arthroplasty using full wedge. (D): right side 12 months follow up and left side 6 months follow up clinical results.