Thursday, January 9, 2014

Shoulder arthritis from suture anchors and screws; Latarjet

One of our first articles about the shoulder, published in 1984 concerned complications of hardware around the shoulder.  We observed that "Screws and staples are used frequently in the surgical treatment of glenohumeral joint problems. We analyzed a series of thirty-seven patients with complications related to the use of these implants. Twenty-one patients had problems related to the use of screws for affixing a transferred coracoid process to the glenoid. Sixteen patients had problems related to the use of staples: ten had undergone capsulorrhaphy, four had had advancement of the subscapularis, and two had had repair of a rotator cuff tear. The complaints at examination were shoulder pain (thirty-six patients), decreased glenohumeral motion (nineteen patients), crepitus with glenohumeral motion (sixteen patients), and radiating paresthesias (four patients). The time between placement of the implant and the onset of symptoms ranged from four weeks to ten years. The screws or staples had been incorrectly placed in ten patients, had migrated or loosened in twenty-four, and had fractured in three. Thirty-four patients required a second surgical procedure specifically for removal of the implant. At operation fourteen patients (41 per cent) were noted to have sustained a significant injury to the articular surface of the glenoid or humerus. The results in this group of patients indicated that screws and staples can produce complications that require reoperation and are capable of causing a permanent loss of joint function. Adequate surgical exposure and careful placement of the implant appear to be essential when these devices are used about the glenohumeral joint."

Here's yet another example of 'anchor arthropathy', which is the modern version of what we discussed 30 years ago. These films are of the right shoulder of a young person having had surgery for shoulder instability. After surgery the shoulder became stiff and painful and did not respond to exercises.
The severe anchor arthritis is apparent.

The individual is scheduled for a ream and run.

Here's another: two days ago we did a ream and run on a young active person with pain and stiffness after a Latarjet. The x-rays show where the screw and bone had been rubbing on the humerus.

At surgery the prominent screw head was seen to be rubbing on the humeral head 

and the bone graft rubbing on the medial humeral cortex.

"Adequate surgical exposure and careful placement of the implant appear to be essential when these devices are used about the glenohumeral joint."

More here.


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