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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Glenohumeral chondrolysis is a rare but devastating complication that can occur after shoulder arthroscopy and thermal capsulorrhaphy. We retrospectively reviewed the medical records and imaging studies of 8 patients in whom glenohumeral chondrolysis developed after shoulder arthroscopy in which thermal energy was used. Of the 8 patients, 5 had previous thermal capsulorrhaphy for the diagnosis of instability. Two patients were diagnosed with instability with associated labral tears and underwent labral repair with thermal capsular shrinkage. One patient was diagnosed with a labral tear and underwent labral debridement with an extensive glenohumeral synovectomy via a thermal probe. No patients had evidence of chondral damage at their index arthroscopy, and none received postoperative pain pumps. In all patients, radiographic evidence of chondrolysis developed and repeat arthroscopy was performed to confirm the diagnosis. Open surgical stabilization has not been known to have this complication, and it is speculated that heating of the joint fluid at the time of arthroscopy from any source plays a role in cartilage death. Further studies are warranted to determine whether adequate outflow during shoulder arthroscopy where the fluid volume is relatively small will aid in avoiding complications associated with the use of heat sources.
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PMID:Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. 1763 23

Idiopathic chondrolysis of the hip is a rare disease in which gradual necrosis of the hyaline cartilage covering the femoral head and acetabulum leads to joint space narrowing and motion restriction. Pain, motion range limitation, and radiographic joint space narrowing are the main manifestations. We report 2 cases in 15-year-old girls, one black and the other Caucasian. Unexplained pain and motion restriction in the left hip were the presenting manifestations. Narrowing of the hip joint space was noted on standard radiographs. Magnetic resonance imaging showed a joint effusion in 1 patient and unevenness of the femoral head contour in the other. Laboratory tests including microbiological studies were normal or negative. Nonspecific synovitis was found in biopsy specimens. Immobilization and traction were the main components of the treatment strategy.
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PMID:Idiopathic chondrolysis of the hip. 1789 63

Idiopathic chondrolysis of the hip is a rare condition occurring mainly in adolescents and is characterised by a rapidly progressive destruction of the articular cartilage in the coxofemoral joint. Patients report intense pain, motion restriction and often limping due to shortening of the limb. The aetiology is not elucidated. Medical imaging techniques form the cornerstone for differential diagnosis. Additionally biological markers for inflammation and infections should be studied. Conservative treatment focuses on pain control and preservation of joint mobility. Because published results of surgical treatment are not conclusive and arthroplasty in young patients is controversial, there is up till now no consensus on the treatment algorithm. Some authors advocate conservative treatment until spontaneous fusion. A case of idiopathic chondrolysis conventionally managed is reported.
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PMID:Idiopathic chondrolysis of the hip: a case report. 1801 24

Chondrolysis following shoulder arthroscopy is a devastating complication, often seen in young patients. After nonoperative measures have been exhausted, there are few treatment options available that reliably improve pain and function. The purpose of this study is to examine the intra-operative findings, radiographic features, and clinical outcomes of a series of patients with chondrolysis following arthroscopic surgery managed with a total shoulder arthroplasty. A retrospective review was performed on 11 patients (average age 39) with shoulder chondrolysis following arthroscopy. Attention was focused on review of the index arthroscopy, radiographs, and functional outcome scores prior to total shoulder arthroplasty, as well as intra-operative cultures, histology, radiographs, and functional outcomes from most recent follow-up. All patients were treated with total shoulder arthroplasty at an average of 26 months after the index arthroscopy. Preoperative and postoperative radiographs were reviewed, and outcomes were compared using validated measurements. Statistically significant improvements in shoulder abduction (89 degrees -123 degrees , P = .027), external rotation (26 degrees -48 degrees , P = .037), total ASES scores (30-77.5, P = .0039), and SST scores (3-8, P = .0078) were noted. Ten patients subjectively rated their outcomes as good or excellent, with 1 as satisfactory. Chondrolysis after shoulder arthroscopy has a rapid clinical progression and is likely multifactorial in etiology. Early results of total shoulder arthroplasty show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients.
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PMID:Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty. 1832 95

The aim of this study was to examine the bony interface underlying a femoral hemiresurfacing implant. The specimen was subjected to radiographic and histologic analyses. The presence of a cement mantle was not uniform throughout the interface. When cement was evident, trabecular bone was found interdigitated within the mantle. When cement was not present, a fibrous tissue membrane was detected between the metal surface of the implant and the host bone. Disruption of the bone stock surrounding the stem was observed. While the reason for the revision was for relief of severe pain for acetabular chondrolysis, bony support of the implant may have been compromised.
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PMID:Analysis of retrieved hemiresurfacing implant. 1914

Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.
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PMID:An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum. 1923 11

There are multiple reports in the literature of chondrolysis following arthroscopic shoulder surgery. Although the etiology of these cases is not known for certain, there has been speculation that radiofrequency devices, young patient age, instability surgery, intra-articular pain pumps, and type of anesthetic may be precipitating factors. This article describes a case of a 37-year-old law enforcement officer who injured both shoulders and ultimately underwent nearly identical bilateral procedures: arthroscopic superior labrum anteroposterior (SLAP) repair, Bankart repair, capsulorrhaphy, acromioplasty, and distal clavicle excision. Intra-articular pain catheters were placed following both procedures, but the right-sided catheter never functioned properly, as evidenced by continuous leakage outside of her body until it was removed. Subsequently she had an arthroscopic lysis of adhesions done for residual stiffness, in which the left humeral head and glenoid cavity were noted to be completely devoid of articular cartilage. Over the ensuing months, multiple cortisone injections, 5 viscosupplementation injections, physical therapy, and narcotics all failed to relieve her left shoulder pain. Radiographs showed significant left glenohumeral joint space narrowing and a normal-appearing joint space on the right. Our impression was postsurgical chondrolysis of the left shoulder. The patient has recently undergone humeral hemiarthroplasty with nonprosthetic glenoid arthroplasty. This case differs from others reported in the literature in that nearly identical bilateral procedures were performed by the same surgeon, yet chondrolysis only developed on the side that had a functioning postoperative pain catheter.
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PMID:Postsurgical chondrolysis of the shoulder. 1930 45

Idiopathic chondrolysis of the hip in children has been well documented in the literature. The insidious nature of the symptoms and lack of early radiographic findings and diagnostic testing often delay diagnosis. Children often report a stiff, painful hip and have an associated limp in the absence of trauma or constitutional symptoms. Despite these symptoms it remains a poorly understood diagnosis with no identifiable cause. Some have speculated an inflammatory cause, as this disease exhibits joint space narrowing, presumably due to enzymatic activity similar to juvenile rheumatoid arthritis. Despite case reports attempting traction, physical therapy, nonsteroidal anti-inflammatories, steroids, and even operative intervention, no current treatment regimen exists that offers proven appreciable benefit. We hypothesized the powerful anti-inflammatory properties of etanercept would provide symptomatic and radiographic improvement of idiopathic chondrolysis of the hip. This article presents a case of an adolescent boy with a stiff, painful left hip that failed treatment with traction, physical therapy, naproxen, and methotrexate, prior to initiating etanercept. After 1 year of daily etanercept therapy, the patient's hip motion improved in all directions and his pain completely resolved. This novel therapeutic approach offered symptomatic relief and radiographic improvement, and may provide an effective treatment strategy for this difficult disease.
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PMID:Idiopathic chondrolysis treated with etanercept. 1930 46

Shoulder arthroscopy has become a routine outpatient surgery. Pain control is a limiting factor for patient discharge after surgery, and several modalities are used to provide continued analgesia postoperatively. Regional anesthetic blocks and shoulder pain pumps are common methods to provide short-term pain control. Shoulder pain pumps can be used either in the subacromial space or within the glenohumeral joint. Several clinical studies suggested--which was confirmed by a bovine and rabbit cartilage study--that there is significant chondrotoxicity from bupivacaine, a local anesthetic commonly used in pain pumps. Postarthroscopic glenohumeral chondrolysis is a noninfectious entity associated with factors including use of radiofrequency thermal instruments and intra-articular pain pumps that administer bupivacaine, but there have been no cases reported with subacromial pain pump placement. Treatment options are difficult in a young patient with postarthroscopic glenohumeral chondrolysis, and understanding the literature with regard to risk factors is paramount to counseling patients and preventing this devastating complication.
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PMID:Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis. 1950 Dec 96

Despite recent advances in cartilage regeneration and restoration procedures, isolated, large, full-thickness cartilage lesions in young patients continue to pose significant challenges to patients and orthopedic surgeons. Treatment options for this difficult problem have traditionally included arthrodesis, osteotomy, osteochondral allograft, and prosthetic reconstruction. We present a case of an adolescent patient with isolated idiopathic lateral tibial chondrolysis treated with a custom ceramic hemi-unicondylar hemiarthroplasty. Preoperatively, a 3-dimensional computed tomography scan of the patient's knee was obtained to begin manufacturing a conforming custom ceramic insert that would articulate between the tibial base plate and the patient's native lateral femoral cartilage. Through a lateral parapatellar approach, the tibial preparation was carried out using the Zimmer M/G unicompartmental knee system (Warsaw, Indiana), and the tibial base plate was cemented into position in the standard fashion. A custom, conforming, prefabricated ceramic insert (CeramTec, Memphis, Tennessee) was then inserted onto the tibial base plate. At 5-year follow-up, this salvage procedure was successful in relieving pain and restoring function in this young patient. There were no signs of implant loosening or lysis. Magnetic resonance imaging of the knee at last follow-up revealed that the cartilage thickness of the patient's lateral femoral condyle remained unchanged. Unicondylar hemiarthroplasty performed in patients with large unipolar lesions in the knee can provide durable and reliable pain relief. Ceramic is a viable material that can be considered for articulation with native cartilage.
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PMID:Ceramic hemi-unicondylar arthroplasty in an adolescent patient with idiopathic tibial chondrolysis. 1963 15


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