In the early 2000s the innovation of using intra-articular pain pumps (devices for administering local anesthetics) were being marketed to manage post arthroscopic pain see The effectiveness of an anesthetic continuous-infusion device on postoperative pain control and The pain control infusion pump for postoperative pain control in shoulder surgery. It was not until a decade later that it was conclusively demonstrated that intra-articular pain pumps caused a devastating type of arthritis in young patients known as chondrolysis: Published evidence demonstrating the causation of glenohumeral chondrolysis by postoperative infusion of local anesthetic via a pain pump
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This is a poignant example of a technological innovation gone bad. We use the term "future shock" to refer to devastating complications from new technologies that are only discovered years after these devices are sold in the marketplace and used in patients. Chondrolysis remains one of the principal indications for shoulder arthroplasty in young individuals.
Consider a 21 year old active male who had a labral repair followed by the implantation of a pain pump. Ten years later he presented to us with progressive pain and stiffness of his shoulder; however he was still able to perform all 12 of the Simple Shoulder Test Functions. His x-rays at that time are shown below.
We advised him that he need not consider arthroplasty until his symptoms progressed.
Another decade later when he was in his early 40s, his symptoms had progressed as indicated by his Simple Shoulder Test
The radiographic appearance of his shoulder had substantially progressed as well.
To avoid the risks and limitations associated with a polyethylene glenoid component he elected to have a ream and run procedure. This was performed without preoperative CT scan, preoperative 3D planning, a nerve block, or an ingrowth humeral component. The long head tendon of the biceps was preserved, the glenoid was reamed conservatively to a single concavity, the thin humeral stem was fixed with impaction autografting.
Shown below are his follow-up x-rays.
As a part of his one year report he indicated, "I can do all my sports, and handle the kids with little and only temporary pain, and am even climbing at around the highest level I've ever climbed." He kindly gave us permission to show some videos of his climbing.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).