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Long-Term Outcomes of Glenohumeral Arthrodesis

Wagner, Eric R., MD1,a; McLaughlin, Richard, MD1,b; Sarfani, Shumaila, MD1; Cofield, Robert H., MD1,c; Sperling, John W., MD, MBA1,d; Sanchez-Sotelo, Joaquin, MD, PhD1,e; Elhassan, Bassem T., MD1,f

doi: 10.2106/JBJS.17.00428
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Background: Glenohumeral arthrodesis is associated with a high rate of complications. Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function. The purpose of this study was to examine the clinical outcomes of glenohumeral arthrodesis.

Methods: Twenty-nine patients with 29 affected shoulders underwent primary glenohumeral arthrodesis between 1992 and 2009. Surgical indications included rotator cuff arthropathy and pseudoparalysis (n = 7), neurologic injuries (n = 12), chronic infection (n = 3), recurrent dislocations (n = 3), and proximal humeral or shoulder girdle tumors (n = 4). Surgical fixation techniques included plates and screws in 18 patients and screws only in 11 patients.

Results: All patients were examined, with a mean follow-up of 12 years (range, 2 to 22 years). Twelve patients (41%) had postoperative complications, including 6 periprosthetic fractures, 7 nonunions, and 3 infections. Eleven patients (38%) required additional surgical procedures after arthrodesis, including revision internal fixation to achieve glenohumeral fusion after nonunions (n = 7), irrigation and debridement with antibiotic treatment for deep infections (n = 2), open reduction and internal fixation to treat fracture (n = 2), and implant removal to treat symptomatic patients (n = 3). Patients experienced reasonable overall pain relief. The mean postoperative scores were 35 points for the Subjective Shoulder Value, 58 points for the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 54 points for the Short Form-36. Eighty-seven percent of patients reported postoperative limitations. Patients with neurologic injuries had worse functional outcomes, and an arthrodesis position of ≥25° yielded better functional outcomes.

Conclusions: Glenohumeral arthrodesis is associated with a high rate of patients with complications (41%). Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

aE-mail address for E.R. Wagner: eric.erwagner@gmail.com

bE-mail address for R. McLaughlin: mclaughlin.richard@mayo.edu

cE-mail address for R.H. Cofield: cofield.robert@mayo.edu

dE-mail address for J.W. Sperling: sperling.john@mayo.edu

eE-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu

fE-mail address for B.T. Elhassan: Elhassan.bassem@mayo.edu

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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