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Postoperative OA in traumatic shoulder instability progresses slowly
Ogawa K. Am J Sports Med. doi:10.1177/0363546510363464.
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In many cases, osteoarthritis that is detected postoperatively actually developed before surgery, according to Japanese researchers.
In their cohort study, Kiyohisa Ogawa, MD, and colleagues at Keio University, Tokyo, reviewed 167 shoulders in 163 patients undergoing open Bankart repair who had no history of shoulder surgery. Through a statistical analysis, they studied the link between osteoarthritis (OA) development and/or progression and patients’ demographic characteristics as well as other various factors. Patients were younger than 45 years at a mean 8.7 years follow-up (range, 5–20 years).
Instability recurred in eight of 167 shoulders. Preoperative computed tomography (CT) revealed that 44 shoulders had OA, of which 12 had OA on the preoperative radiographs.
The CT-proven OA in the 32 remaining shoulders was in the beginning stages and was not identified via radiographs, according to the researchers.
Follow-up radiographs showed that 30 shoulders had OA; 24 had OA proven by preoperative imaging. In 20 shoulders, OA that was proven by preoperative CT never showed up on postoperative radiographs.
During the postoperative period, OA severity increased slightly in 14 joints. In the 30 shoulders with postoperative OA, there were significantly more preoperative subluxations and a greater total number of dislocations/subluxations. In addition, this group had more men and more glenoid bone defects that measured greater than 20% of the anteroposterior diameter.
This is a long-term follow up on a cohort with chronic instability and preoperative computed tomography evaluation for osteoarthritis. At follow-up, 18% of patients had developed arthritis, 80% of which had preoperative evidence of arthritis. Osteoarthritis correlated with the number of instability events and glenoid bone loss.
These results suggest that the osteoarthritis is the result of the chronic instability and not the stabilization surgery. This paper lends further support to the concept of early surgical stabilization of dislocations in at-risk patients (young males) to prevent recurrent instability.
— Brett D. Owens, MD
LTC MC USA
Associate Professor
John A. Feagin, Jr. Sports Medicine Fellowship
Keller Army Hospital
West Point, NY