Published online Mar 18, 2017. doi: 10.5312/wjo.v8.i3.229
Peer-review started: July 1, 2016
First decision: October 21, 2016
Revised: November 13, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: March 18, 2017
Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients.
Core tip: Non-anatomic stabilization procedures may result in overconstraint or incongruence of the glenohumeral joint with resultant instability arthropathy. Proud suture anchors can create a traumatic wear pattern resulting in an iatrogenic arthropathy. Secondary arthropathy may occur in up to two-thirds of patients after Bankart repair and 30% after coracoid transfer at mid- to long-term follow-up, although clinical outcomes may vary. When conservative measures have failed, various arthroscopic procedures may be considered to address mechanical symptoms and other pain generators. Total shoulder arthroplasty remains the most reliable option for advanced instability arthropathy, although concern exists above survivorship in patients under 50 years.