Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty Jonathan C. Levy, MD, a Nazeem A. Virani, MD, b Mark A. Frankle, MD, c Derek Cuff, MD, d Derek R. Pupello, MBA, b and Jeff A. Hamelin, PA-C, c Fort Lauderdale, Tampa, and Venice, FL 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  -123  , P ¼ .027), external rotation (26  -48  , P ¼ .037), total ASES scores (30-77.5, P ¼ .0039), and SST scores (3-8, P ¼ .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. (J Shoulder Elbow Surg 2008;17:380-388.) Glenohumeral chondrolyisis following shoulder arthroscopy has been reported in several case re- ports. 13,16,22,24,29 The true etiology has yet to be identi- fied. Suggestions of chemical chondrocyte toxicity of gentian violet, 29 radiofrequency or laser dam- age, 8,9,12,16-18 immunologic reaction, 24 and infection have all been reported as possible causes. Common to all reports is an unexpected, rapidly progressive obliter- ation of the glenohumeral joint space following an arthroscopic procedure. Only 1 series has reported the use of arthroplasty in the management of these patients. Levine et al re- ported the use of humeral head resurfacing with a me- niscal interposition allograft to manage 2 patients with chondrolysis after arthroscopic thermal capsulorrha- phy; 16 however, the long-term durability of this recon- struction has not been documented. The selection of total shoulder arthroplasty (TSA) to manage these patients has been questioned, as patients with chon- drolysis following shoulder arthroplasty tend to be younger. Nonetheless, the longevity of TSA has been shown to be similar to that of hemiarthroplasty in pa- tients younger than 50 years old. 5,28 The hypothesis is that TSA can be used to treat patients with chondrol- ysis following previous arthroscopy successfully. To prove this hypothesis, we examined the clinical course, intra-operative findings, and outcomes of a se- ries of young patients with chondrolysis managed with a TSA. MATERIALS AND METHODS Between January 2001 and August 2004, a TSA was used to treat 11 patients with chondrolysis that developed after shoulder arthroscopy. Three were referred with the di- agnosis of chondrolysis. Of the remaining 8, the diagnosis of chondrolysis was made at an average of 16 months (range, 3-27 months) from the index arthroscopic proce- dure. Follow-up averaged 37 months (range, 24-66 months) From the a Orthopaedic Institute at Holy Cross Hospital, Fort Lauderdale; b Florida Orthopaedic Institute Research Foundation, Tampa; c Shoulder & Elbow Division, Florida Orthopaedic Institute, Tampa; and d Suncoast Orthopaedic Surgery & Sports Medicine, Venice, FL Reprint requests: Mark Frankle, MD, Chief of Shoulder and Elbow Division, Florida Orthopaedic Institute, 13020 N Telecom Park- way, Tampa, FL 33637 (E-mail: frankle@pol.net). Copyright ª 2008 by Journal of Shoulder and Elbow Surgery Board of Trustees. 1058-2746/2008/$34.00 doi:10.1016/j.jse.2007.11.004 380