Factors linked to advancement of dislocation arthropathy

In a 25-year follow-up of 223 shoulders, 26% developed moderate or severe arthropathy.

Issue: Issue 3 2008

SAN FRANCISCO — New Swedish research indicates alcohol abuse, age, degree of trauma and instability outcomes are factors contributing to arthropathic progression 25 years after first-time shoulder dislocation. The study also finds significantly less arthropathy in shoulders without recurrence.

In a prospective, multicenter study, Lennart Hovelius, MD, and colleagues completed a 25-year radiographic follow-up of patients aged 40 years or younger who received conservative treatment for first-time anterior shoulder dislocations.

“After 25 years, 29% had mild arthropathy, 9% had moderate and 17% severe,” Hovelius said during his presentation at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. “Totally, 26% had moderate or severe arthropathy.”

Severe arthropathy

The investigators also found that all seven alcoholic patients who had X-rays had severe arthropathy, and that patients younger than 25 years at the time of dislocation had significantly less arthropathy than older patients (P=.01) at the long-term follow-up.

In addition, they found that significantly more patients involved in traumatic sports activity had moderate and severe arthopathy compared to those who participated in a nontraumatic sports activity (P=.009), and that patients with a single dislocation had significantly less arthropathy than those with continuing recurrent instability and those whose dislocations stabilized over time.

Using conventional radiographs, two investigators evaluated 223 shoulders at 25-year follow-up and noted the degree of arthropathy using the Samilson and Prieto classification. They also defined patients’ shoulder prognosis using the following four endpoints:

non-recurrent;
stable over time;
still recurrent; and,
surgically stabilized.

The study revealed that only 8% of patients who were between 34 and 40 years old at the time of their dislocation underwent surgical stabilization during the 25-year follow-up, compared to 50% of patients who were between the ages of 12 and 16 years.

The long-term study also showed that fewer solitary dislocated shoulders had severe or moderate arthropathy (17%) compared to surgically stabilized shoulders (21%), shoulders that had one recurrence (35%), those categorized as still recurrent (29%), and shoulders with a dislocation that stabilized over time (45%).

Shoulder incongruity

The investigators also examined the association between shoulder incongruity and arthropathy over time.

“At 10 years, 33 shoulders were incongruent,” Hovelius said. “At 25 years, we found that of incongruent joints, 61% had moderate or severe arthropathy.” However, they discovered that only 24% of congruent shoulders at 10-year follow-up had moderate or severe arthropathy at 25-year follow-up.

They also found that shoulders with severe arthropathy at 25 years had significantly worse DASH scores (P=.001).

“The median value for shoulders with severe arthropathy was more than 10 and differed from shoulders with normal, mild or moderate arthropathy,” he said.

For more information:
Lennart Hovelius, MD, can be reached at the Orthopaedic Department of Gävle Hospital, Gävle, Sweden; +46-(0)90-261-54-000; or the Division of Surgery and Perioperative Science, Department of Orthopaedics, Umeå University Hospital, SE-901 87 Umeå, Sweden; 46-(0)90-786-50-00; e-mail: hovelius@tele2.se.

Reference:
Hovelius L, Skoglund UIP, Sandstrom B, et al. The evolution of arthropathy in anterior shoulder dislocation. 223 shoulders followed for 25 years. Paper #247. Presented at 75th Annual Meeting of the American Academy of Orthopaedic Surgeons. March 5-9, 2008. San Francisco.