In the JournalsPerspective

Glenohumeral arthrodesis can provide pain relief, but carries complications

Glenohumeral arthrodesis was shown to relieve pain, but patients were at high risk for complications and limited shoulder function, according to study published in The Journal of Bone and Joint Surgery.

Eric Wagner photo
Eric R. Wagner

“Given the preoperative disability many of these patients are faced with and the lack of alternatives, glenohumeral fusion is able to relieve pain and maintain a reasonable level of function over the long term,” Eric R. Wagner, MD, a co-author of the study, told Healio.com/Orthopedics. “However, this is a complex procedure associated with a high rate of complications and functional limitations. The study highlights that this is especially true in the paralytic shoulder, where alternatives to glenohumeral fusion should be exhausted prior to considering this procedure.”

The retrospective study included 29 patients who underwent glenohumeral arthrodesis between 1992 and 2009 and had a mean follow-up of 12 years. Wagner and his colleagues examined demographic characteristics, comorbidities, surgical indications, operative information on prior treatments, pain relief, range of motion and patient surveys. Patient surveys included the DASH, shoulder subjective value and SF-36 questionnaires and questions regarding their satisfaction, limitations and employment.

Results showed 29 patients experienced reasonable pain relief and 34% of patients reported moderate or severe postoperative pain. Postoperative complications developed in 41% of patients and included nonunion, periprosthetic fracture and infection. Overall, 38% of patients underwent additional surgical procedures. The mean scores for patient questionnaires were 58 for the DASH, 35 for the shoulder subjective value and 54 for the SF-36. According to patient surveys, 43% of patients returned to work full-time and 30% returned to work part-time.

Investigators found 87% of patients reported postoperative limitations; however, patients with neurological injuries experienced greater limitations than those with non-neurological injuries. For patients with neurological injuries, 25% could reach their mouth or back pocket, while 76% of patients with non-neurological injuries could reach their mouth and 53% could reach their back pocket. Patients with an arthrodesis position of less than 25° experienced better outcomes including better shoulder flexion, shoulder abduction and ability to reach their mouth, as well as less postoperative pain. – by Laura Kincaid and Monica Jaramillo

 

 

Disclosure: Wagner reports no relevant financial discourses.

 

Glenohumeral arthrodesis was shown to relieve pain, but patients were at high risk for complications and limited shoulder function, according to study published in The Journal of Bone and Joint Surgery.

Eric Wagner photo
Eric R. Wagner

“Given the preoperative disability many of these patients are faced with and the lack of alternatives, glenohumeral fusion is able to relieve pain and maintain a reasonable level of function over the long term,” Eric R. Wagner, MD, a co-author of the study, told Healio.com/Orthopedics. “However, this is a complex procedure associated with a high rate of complications and functional limitations. The study highlights that this is especially true in the paralytic shoulder, where alternatives to glenohumeral fusion should be exhausted prior to considering this procedure.”

The retrospective study included 29 patients who underwent glenohumeral arthrodesis between 1992 and 2009 and had a mean follow-up of 12 years. Wagner and his colleagues examined demographic characteristics, comorbidities, surgical indications, operative information on prior treatments, pain relief, range of motion and patient surveys. Patient surveys included the DASH, shoulder subjective value and SF-36 questionnaires and questions regarding their satisfaction, limitations and employment.

Results showed 29 patients experienced reasonable pain relief and 34% of patients reported moderate or severe postoperative pain. Postoperative complications developed in 41% of patients and included nonunion, periprosthetic fracture and infection. Overall, 38% of patients underwent additional surgical procedures. The mean scores for patient questionnaires were 58 for the DASH, 35 for the shoulder subjective value and 54 for the SF-36. According to patient surveys, 43% of patients returned to work full-time and 30% returned to work part-time.

Investigators found 87% of patients reported postoperative limitations; however, patients with neurological injuries experienced greater limitations than those with non-neurological injuries. For patients with neurological injuries, 25% could reach their mouth or back pocket, while 76% of patients with non-neurological injuries could reach their mouth and 53% could reach their back pocket. Patients with an arthrodesis position of less than 25° experienced better outcomes including better shoulder flexion, shoulder abduction and ability to reach their mouth, as well as less postoperative pain. – by Laura Kincaid and Monica Jaramillo

 

 

Disclosure: Wagner reports no relevant financial discourses.

 

    Perspective
    Samer S. Hasan

    Samer S. Hasan

    A generation ago glenohumeral arthrodesis or fusion was an option, if not the preferred option, for the young laborer with painful advanced glenohumeral arthritis and the salvage option for terminal glenohumeral instability. Wagner and his colleagues at Mayo Clinic report the long-term outcomes of 29 patients who underwent glenohumeral arthrodesis over an 18-year period for various indications including severe brachial plexus injury, chronic dislocation, cuff tear arthropathy and failed prosthetic shoulder arthroplasty (PSA). Despite the use of pelvic reconstruction plates or multiple screws and supplemental bone grafting, nonunion that required further surgery occurred in 7 of 29 patients; 12 patients (41%) had a complication and 11 patients required reoperation. Patient-reported outcomes were dismal with a mean subjective shoulder value of only 35. Interestingly, 11 of 29 patients underwent arthrodesis for cuff tear arthropathy or a failed PSA and it is unclear how many of these procedures were done prior to late 2003, when reverse shoulder arthroplasty (RSA) became widely available in the United States. The findings support choosing RSA over arthrodesis for any cuff tear arthropathy patient with painful pseudoparalysis, irrespective of age, because the results of RSA are superior and because arthrodesis can still be employed to salvage the rare failed PSA that cannot be revised. The rare patient with severe brachial plexus injury or marked combined deltoid and rotator cuff dysfunction that may benefit from glenohumeral arthrodesis today is probably best treated at one of a small handful of centers with ongoing experience in this area. In summary, the small number of patients in this study — an average of three patients every 2 years from a major tertiary referral center — confirms arthrodesis is a disappearing procedure and the generally poor outcomes suggest it is probably best it is going this way.

    • Samer S. Hasan, MD, PhD
    • Clinical director, Mercy Health, Cincinnati Sports Medicine and Orthopedic Center, Cincinnati

    Disclosures: Hasan reports no relevant financial disclosures.