Pharmaceutical

Surgeons discuss characteristics of chondrolysis caused by pain pumps

Characteristics of chondrolysis associated with intra-articular pain pumps after shoulder surgery was among the topics at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons/ the American Association of Orthopaedic Surgeons. The discussion included Drs. Peter Thomas Scheffel, Jeremiah Clinton, Joseph Lynch, Winston J. Warme, and Frederick A. Matsen III, and was moderated by Drs. Carl J. Basamania and Guido Marra. The message centered on the need for surgeons and patients to be aware of chondrolysis as a potential complication of the infusion of local anesthetic after shoulder arthroscopy.

A recent study published in The American Journal of Sports Medicine first brought to light the connection between chondrolysis, a condition in which the cartilage has been eroded away, and the use of pain pumps during and following surgery. This type of chondrolysis, characterized by the complete loss of articular cartilage from the humeral head and glenoid, has been associated with intra-articular injection of dye, and with the post-arthroscopy infusion of local anesthetic into the joint.

Sixty-six cases of chondrolysis associated with shoulder arthroscopy followed by the intra-articular pain pumps with local anesthetic were identified among men and women between the ages of 15 and 57. Fifty-five of those patients had normal joint surfaces at the time of arthroscopy. All patients who suffered from chondrolysis suffered from pain and loss of motion that began between 91 to 1,650 days following surgery.

While pain pumps are approved by the Food and Drug Administration (FDA) to deliver pain medication into the shoulder tissue, they are not approved for use with the catheters placed directly in the joint space, as pain pump manufacturers had instructed surgeons. It is believed this non-approved practice led the anesthetic to erode the cartilage in the shoulder.