Summary

This study reports clinical and patient reported outcome measures in patients undergoing revision surgery after diagnosis of anchor-inducted arthropathy.

Abstract

Purpose

To report clinical and patient reported outcome measures in patients undergoing revision surgery after diagnosis of anchor-inducted arthropathy.

Methods

Consecutive patients were identified at a single institution (XX, blinded for review) who underwent revision arthroscopic shoulder surgery and were diagnosed with post-instability glenohumeral arthropathy performed between January 2000 and May 2018. Data included initial diagnosis and index procedure performed, presenting arthropathy symptoms including duration, exam findings prior to revision surgery, and surgical intervention. Patient reported outcome measures (PROMs) were collected prior to surgery and at minimum 2-year follow-up.

Results

Fifteen patients were included with a mean age at presentation of 33.9 +/- 12.9 years (range = 16 – 59). The follow-up rate was 87% with a mean follow-up of 3.9 years (range = 1.1 - 10.6). Almost half of all patients (7/15, 47%) presented with symptoms within ten months after index arthroscopic procedure consisting of extensive pain and stiffness. Overall, the mean time interval between index arthroscopic procedure to development of arthropathy symptoms was 51.0 months (2 months – 13.8 years). Subjective symptoms at time of presentation included pain (87%) and instability (33%). All patient presented with stiffness on exam. At time of revision surgery, nine patients underwent Comprehensive Arthroscopic Management (CAM) while 6 underwent implant removal with revision stabilization procedures. Pain significantly improved in 74% of patients (p < 0.01). Significant improvements in all PROMs were observed to include SF-12 (43.1 to 53.2, p<0.01), QuickDASH (34.6 to 11.7, p<0.01), SANE (43.4 to 81.6, p < .05) and ASES (59.0 to 89.5, p < 0.01). External rotation significantly improved from 31.9° ± 22.7 to 52.9° ± 24.1 (p < .05).

Conclusion

Surgeons should have a low threshold for early arthroscopic intervention to assess the painful and stiff shoulder after instability repair if anchor arthropathy is suspected. Rapid intervention once diagnosed through either revision arthroscopic or open debridement and/or stabilization can lead to significant improvement in range of motion, pain, and overall patient function and satisfaction, however, this is a challenging population.

Clinical Relevance: Improvement in Patient Reported Outcome Measures results from rapid surgical intervention as soon as anchor arthropathy is identifie, although not all patients demonstrated optimal improvement.