Alternative Viewpoints on Chondrolysis
An alternative theory as to the cause of chondrolysis is with the use of postoperative intra-articular pain pump catheters. A paper entitled "Post-arthroscopic Shoulder Chondrolysis with Associated Intra-articular Pain Pump Catheter Use" reports on the details. The group of investigators reviewed the charts of 152 patients who underwent 177 shoulder arthroscopies between January 1, 2003 and December 31, 2005 and looked for postarthroscopic chondrolysis. Twelve shoulders in 10 patients who underwent arthroscopic stabilization developed chondrolysis. Eighty-three percent of these required a subsequent procedure. All patients who developed chondrolysis had been treated postoperatively with an intra-articular pain pump catheter with bupivacaine containing epinephrine. Seven other patients treated with the pain pump catheters had not developed chondrolysis. All chondrolysis cases occurred after beginning the use of a larger pain pump, which infused this medication at 4.16 cc/hour over 2 or 3 days. Although the exact cause and mechanism of chondrolysis is still unknown, the study authors believe that there is a significant and previously unrecognized risk associated with the use of intra-articular pain pump catheters and bupivacaine with epinephrine. The study authors conclude that intra-articular pain pump catheters should be used with caution until the safety of constantly infusing local anesthetics intra-articularly is better defined.
