Neer Award 2008: Arthropathy after primary anterior shoulder dislocation--223 shoulders prospectively followed up for twenty-five years.
BACKGROUND
Shoulder dislocation may cause arthropathy, but the natural history of this evolution is not well described. We therefore conducted a radiographic follow-up 25 years after the primary shoulder dislocation.


METHODS
A prospective Swedish multicenter study (1978-1979) included 257 shoulders in 255 patients (age, 12-40 years) with a first-time anterior shoulder dislocation. After 25 years, 227 patients (229 shoulders) were alive and had follow-up. Radiographic imaging was performed in 223 shoulders (97%).


RESULTS
Shoulders were normal in 44%. Arthropathy was mild in 29%, moderate in 9%, and severe in 17%. Of the shoulders without a recurrence, 18% had moderate/severe arthropathy. The corresponding figures were 39% for shoulders that recurred once or more (without surgery) and 26% (16 of 62) for surgically stabilized shoulders. Seven of 221 patients (7 of 223 shoulders) were considered alcoholic at 25 years and all had severe arthropathy (P < .001). Other factors that correlated with moderate/severe arthropathy were age older than 25 years at primary dislocation (P = .01) and primary dislocation caused by high-energy sports activity (P = .009). Shoulders that had not recurred had less arthropathy than shoulders classified as recurrent (P = .047) or stabilized over time (P = .007). Sixty-two surgically stabilized shoulders had less arthropathy than those that became stable over time (P = .047). Mild arthropathy at 10 years was associated with moderate/severe arthropathy at 25 years in 19 of 30 shoulders (63%) compared with 13 of 146 (9%) classified as normal at 10 years (P < .001). Joint incongruence at 10 years was associated with moderate/severe arthropathy at 25 years (P = .001).


CONCLUSIONS
Age at primary dislocation, recurrence, high-energy sports, and alcohol abuse were factors associated with the development of arthropathy. Also shoulders without a recurrence were associated with arthropathy.
Hovelius
Lennart
L
Division of Surgery and Perioperative Science, Department of Orthopedics, Umeå University Hospital, Umeå, Sweden; Orthopedic Department, Gävle Hospital, Gävle, Sweden. hovelius@swipnet.se
Saeboe
Modolv
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000700:Analgesics / Q000627:therapeutic use; D001363:Awards and Prizes; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000379:methods; D015994:Incidence; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D026741:Physical Therapy Modalities; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012783:Shoulder Dislocation / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
D000700:Analgesics