Saturday, May 3, 2014

Total shoulder arthroplasty for capsulorrhaphy arthropathy

Intermediate and long-term follow-up of total shoulder arthroplasty for the management of postcapsulorrhaphy arthropathy.

These authors reviewed 22 shoulders with arthritis following a prior procedure for instability (capsulorrhaphy arthropathy). There were 21 men and 1 woman, with the dominant extremity being affected in 13 patients. At the time of surgery, these patients were a mean age of 55 ± 13 years (range, 33-83 years), and 9 were aged younger than 50 years. Fourteen patients had undergone 1 instability procedure on the affected shoulder, whereas 4 patients had undergone 2 previous surgeries, 3 patients had undergone 3 previous surgeries, and 1 patient had undergone 7 previous surgeries. Stabilization procedures included a Magnuson-Stack procedure in 8 patients, arthroscopic stabilization in 4, Putti-Platt in 4, Bristow in 1, Nicola in 1,  capsular shift 1, and 2 patients underwent open instability procedures that were not otherwise specified. One patient had undergone multiple instability surgeries. The mean interval from the stabilization procedure to the TSA was 26.5 ± 15.5 years. 

Eight of the 22 shoulders underwent a total of 13 reoperations. Shoulders with subscapularis deficiency had poorer active flexion. Five of the shoulders required repair of the subscapularis.  Eight patients had radiographic evidence of implant subluxation. Two shoulders showed mild subluxation (1 each anterior and posterior), 3 showed moderate subluxation (anterior), and 3 shoulders showed severe subluxation (2 anterior, 1 posterior).

Comment: Capsulorrhaphy arthropathy is a relatively common diagnosis among young individuals having shoulder arthroplasty. The patients are often physically active and have high expectations of their surgery. The surgery is complicated by the fact that the prior instability procedure has often limited external rotation, so that soft tissue balancing is difficult and the subscapularis repair is under additional load during rehabilitation. Not infrequently, the tight anterior capsule has resulted in posterior humeral subluxation and posterior glenoid erosion - the bad arthritic triad. As is shown in this paper, the shoulder arthroplasty is often performed decades later.

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