Long-Term Outcomes of Glenohumeral Arthrodesis.

Abstract

BACKGROUND:

Glenohumeral arthrodesis is associated with a high rate of complications. Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function. The purpose of this study was to examine the clinical outcomes of glenohumeral arthrodesis.

METHODS:

Twenty-nine patients with 29 affected shoulders underwent primary glenohumeral arthrodesis between 1992 and 2009. Surgical indications included rotator cuff arthropathy and pseudoparalysis (n = 7), neurologic injuries (n = 12), chronic infection (n = 3), recurrent dislocations (n = 3), and proximal humeral or shoulder girdle tumors (n = 4). Surgical fixation techniques included plates and screws in 18 patients and screws only in 11 patients.

RESULTS:

All patients were examined, with a mean follow-up of 12 years (range, 2 to 22 years). Twelve patients (41%) had postoperative complications, including 6 periprosthetic fractures, 7 nonunions, and 3 infections. Eleven patients (38%) required additional surgical procedures after arthrodesis, including revision internal fixation to achieve glenohumeral fusion after nonunions (n = 7), irrigation and debridement with antibiotic treatment for deep infections (n = 2), open reduction and internal fixation to treat fracture (n = 2), and implant removal to treat symptomatic patients (n = 3). Patients experienced reasonable overall pain relief. The mean postoperative scores were 35 points for the Subjective Shoulder Value, 58 points for the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 54 points for the Short Form-36. Eighty-seven percent of patients reported postoperative limitations. Patients with neurologic injuries had worse functional outcomes, and an arthrodesis position of ≥25° yielded better functional outcomes.

CONCLUSIONS:

Glenohumeral arthrodesis is associated with a high rate of patients with complications (41%). Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Authors: Eric R Wagner, Richard McLaughlin, Shumaila Sarfani, Robert H Cofield, John W Sperling, Joaquin Sanchez-Sotelo, Bassem T Elhassan
• Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am) Vol. 100 Issue 7 Pg. 598-604 (Apr 04 2018) ISSN: 1535-1386 [Electronic] United States
• PMID: 29613929 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Arthralgia (surgery)
• Arthrodesis (adverse effects, instrumentation, methods)
• Bone Plates
• Bone Screws
• Female
• Follow-Up Studies
• Humans
• Joint Diseases (surgery)
• Male
• Middle Aged
• Postoperative Complications (etiology, physiopathology)
• Range of Motion, Articular (physiology)
• Retrospective Studies
• Rotator Cuff Tear Arthropathy (physiopathology, surgery)
• Shoulder Injuries
• Shoulder Joint (physiology, surgery)
• Trauma, Nervous System (physiopathology, surgery)
• Treatment Outcome
• Young Adult