title: Glenohumeral arthrodesis for the treatment of recurrent shoulder instability in epileptic patients.
abstract: We report our experience with glenohumeral arthrodesis as a salvage procedure for epilepsy-related recurrent shoulder instability. A total of six patients with epilepsy underwent shoulder fusion for recurrent instability and were followed up for a mean of 39 months (12 to 79). The mean age at the time of surgery was 31 years (22 to 38). Arthrodesis was performed after a mean of four previous stabilisation attempts (0 to 11) in all but one patient in whom the procedure was used as a primary treatment. All patients achieved bony union, with a mean time to fusion of 2.8 months (2 to 7). There were no cases of re-dislocation. One revision was undertaken for loosening of the metalwork, and then healed satisfactorily. An increase was noted in the mean subjective shoulder value, which improved from 37 (5 to 50) pre-operatively to 42 (20 to 70) post-operatively although it decreased in two patients. The mean Oxford shoulder instability score improved from 13 pre-operatively (7 to 21) to 24 post-operatively (13 to 36). In our series, glenohumeral arthrodesis eliminated recurrent instability and improved functional outcome. Fusion surgery should therefore be considered in this patient population. However, since the majority of patients are young and active, they should be comprehensively counselled pre-operatively given the functional deficit that results from the procedure.
authors.affiliation: Royal National Orthopaedic Hospital Stanmore, The John Scales Centre for Biomedical Engineering, IOMS, Division of Surgery and Interventional Science, University College London, HA7 4LP, UK.
authors.forename: T
authors.initials: T
authors.lastname: Thangarajah
authors.affiliation: The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.affiliation: The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK.
authors.forename: I
authors.initials: I
authors.lastname: Bayley
authors.affiliation: The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Lambert
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arthrodesis; Joint instability; Shoulder joint