Scientific Article   |    
Shoulder Arthroplasty in Patients with a Prior Anterior Shoulder Dislocation Results of a Multicenter Study
J. Matsoukis, MD; W. Tabib, MD; P. Guiffault, MD; A. Mandelbaum, MD; Gilles Walch, MD; Chantal Némoz, PhD; T. Bradley Edwards, MD
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Investigation performed at the Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, Lyon, France

J. Matsoukis, MD
W. Tabib, MD
P. Guiffault, MD
A. Mandelbaum, MD
Department of Orthopaedic Surgery, Groupe Hospitalier du Havre, Hôpital Jacques Monod, BP 24, 76083 Le Havre CEDEX, France

Gilles Walch, MD
Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, 85 Cours Albert Thomas, 69003 Lyon, France

Chantal Némoz, PhD
Department of Biostatistics, Hôpitaux de Lyon, 162 Avenue Lacassagne, 69424 Lyon CEDEX 03, France

T. Bradley Edwards, MD
Fondren Orthopaedic Group, 7401 South Main Street, Houston, TX 77030

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Association pour le Développement de la Pathologie de l'Épaule. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Tornier Company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

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J Bone Joint Surg Am, 2003 Aug 01;85(8):1417-1424
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Background: Prior reports of shoulder arthroplasty performed for dislocation-induced arthropathy have included only patients who had had a prior stabilizing procedure. The purpose of this study was to report the results of shoulder arthroplasty in all patients with a prior anterior shoulder dislocation, including both those previously treated operatively and those previously treated nonoperatively.

Methods: Fifty-five shoulders undergoing arthroplasty for arthritis following a prior anterior shoulder dislocation were evaluated. Twenty-seven of the shoulders had undergone a prior anterior stabilization procedure. The measures used to evaluate the shoulders included the Constant score, adjusted Constant score, active mobility, subjective satisfaction, radiographic result, and complications.

Results: The shoulders were evaluated at a mean of 45.0 months. The Constant score improved from a mean of 30.8 points preoperatively to a mean of 65.8 points at the time of follow-up. The adjusted Constant score improved from a mean of 38.2% to a mean of 79.8%. Active forward flexion improved from a mean of 82.1° to a mean of 138.9°. Active external rotation improved from a mean of 4.0° to a mean of 38.6°. Fifty patients rated the result as good or excellent. Negative prognosticators included an older age at the time of the initial dislocation and a rotator cuff tear. No significant differences in demographic factors, pre-arthroplasty function, post-arthroplasty function, pre-arthroplasty radiographic findings, post-arthroplasty radiographic findings, complication rate, or reoperation rate were noted between the patients treated with a prior operation for the anterior instability and those treated nonoperatively.

Conclusions: This investigation documented the good results obtainable with shoulder arthroplasty for the treatment of arthritis following anterior shoulder instability. In addition, our findings suggest that capsulorrhaphy-induced arthropathy may be indistinguishable from arthritis following nonoperatively treated anterior shoulder instability.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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