These authors sought to determine the impact of prior arthroscopic management of glenohumeral arthritis in the young patient on results of subsequent anatomic shoulder arthroplasty.
Patients were included in the study group if they had an arthroscopic debridement or capsular release in the setting of glenohumeral arthritis without other shoulderpathology (such as labral or rotator cuff injury). Patients were excluded from the study group if they (1) underwent reverse total shoulder arthroplasty; (2) had prior rotator cuff repair, instability surgery, or fracture fixation; (3) had prior open surgery; (4) had a diagnosis of capsulorrhaphy arthropathy, avascular necrosis, chondrolysis, post-traumatic arthritis, rheumatoid arthritis, or any other diagnosis other than glenohumeral osteoarthritis; and (5) were over the age of 65 at the time of arthroscopic surgery.
43 patients having a total shoulder or ream-and-run arthroplasty with a prior history of arthroscopic management were matched to 86 patients having shoulder arthroplasty without prior surgery. Cases were matched by age, sex, Walch classification, and type of arthroplasty.
Patients with prior arthroscopic debridement/capsular release had their arthroscopic procedures at a mean age of 50 years and at a mean of 10 years prior to shoulder arthroplasty.
The mean 2 year Simple Shoulder Test (SST) scores (10.3 vs. 9.9), percent of maximal possible improvement (75.4 vs. 73.0%), SANE scores (79.6 vs. 79.8), and % of patients to exceed the MCID for the SST (89 vs. 91%) and SANE score (86 vs. 75%) were statistically similar in patients with prior arthroscopic debridement compared with those without prior arthroscopic debridement. The rate of MUA (9 vs. 6%) and open revision (9 vs. 8%) were also statistically similar between the two groups.
The results for anatomic total shoulder and for the ream and run procedure are shown below.
Previous arthroscopic and open surgery have been reported to be associated with decreased function, increased pain, and higher complication rates after subsequent arthroplasty (see link, link, and link). Other reports link prior surgery can lead to an increase in infections (see link, and link).
It seems likely that the lack of negative effect of pre-arthroplasty arthroscopy noted in this study is related to the long interval between the two procedures allowing for risks, such as that for infection, to return to the levels seen in patients without prior arthroscopy.
In our practice we have observed that young age, male sex and prior surgery are risk factors for periprosthetic infection (PJI). In patients with increased risk for PJI we consider extraordinary prophylaxis, including Betadine lavage, topical antibiotics and postoperative oral antibiotics.
