Glenohumeral chondrolysis after shoulder arthroscopy associated with continuous bupivacaine infusion

Rapley JH, Beavis RC, Barber FA; Arthroscopy 25 (12), 1367-73 (Dec 2009)

PURPOSE: To determine the incidence of glenohumeral chondrolysis associated with the use of a continuous-infusion device in shoulder arthroscopy. METHODS: A consecutive series of patients undergoing arthroscopic glenohumeral surgery with a postoperative continuous-infusion pump inserted into either the glenohumeral joint or subacromial space were evaluated for chondrolysis. Two pump types were used: group 1 received 100 mL of 0.5% bupivacaine without epinephrine infused at 2.08 mL/h, and group 2 received 270 mL of 0.5% bupivacaine without epinephrine infused at 4.16 mL/h. RESULTS: We followed up 65 patients at a mean of 40 months. Of these, 29 had glenohumeral catheters (13 in group 1 and 16 in group 2) and 36 had subacromial catheters (19 in group 1 and 17 in group 2). The overall postoperative Constant, American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, and Simple Shoulder Test scores were 84, 87, 77, 86, and 10, respectively, in those with glenohumeral catheters and 93, 94, 95, 89, and 11, respectively, in those with subacromial catheters. Three glenohumeral catheter patients were diagnosed with chondrolysis, all in group 2. CONCLUSIONS: Chondrolysis developed in 3 of 16 patients (19%) with glenohumeral joint infusion of 0.5% bupivacaine without epinephrine at 4.16 mL/h for 65 hours. No patient using a 2.08-mL/h reservoir for 48 hours into the glenohumeral joint and no patient with a subacromial infusion device had chondrolysis. Clinical symptoms and radiographic evidence of chondrolysis developed before 12 months after surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.