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Similar quality of life seen with open vs arthroscopic surgery for shoulder instability patients
There was no difference in quality of life outcomes between patients with recurrent traumatic shoulder instability who underwent either open or arthroscopic stabilization, although the recurrence of shoulder instability was higher after arthroscopic stabilization.
“There was no difference between open and arthroscopic repair in terms of patient quality of life,” the researchers wrote in their abstract. “Open repair resulted in a significantly lower risk of recurrence.”
In the prospective trial, researchers compared patients with traumatic shoulder instability randomized to either open or arthroscopic shoulder stabilization. There were 98 patients in each group, and the researchers performed expertise-based randomization to avoid differential bias of physician experience. They measured outcomes at baseline, 3 months, 6 months, 1 year and 2 years postoperatively.
Seventy-nine patients in the open group and 83 patients in the arthroscopic group were available for 2-year follow-up. The researchers noted no differences between the groups at baseline.
At 2 years, the Western Ontario Shoulder Instability Index score was higher in the open group at 85.2 points vs. 81.9 points in the arthroscopic group, but the difference was not significant.
American Shoulder and Elbow Scores (ASES) were significant within each group, but were not significantly different between groups at 2-year follow-up. The mean ASES score was 91.4 points in the open group and 88.2 points in the arthroscopic group.
The recurrence rate at 2 years was significantly higher in the arthroscopic group with a rate of 23% compared to 11% in the open group. Men aged 25 years or younger with a Hills-Sachs lesion were more likely to have recurrent instability.
“Secondary outcome data from this trial suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hills-Sachs lesion,” the authors wrote in the abstract. — by Renee Blisard Buddle
Disclosures: Boorman has no relevant financial disclosures. Hannaford was the biostatistician for the data analysis of the study. Hiemstra is a consultant for ConMed Linvatec, receives grants from Lifemark Health, ConMed Linvatec, and Sanofi Genzyme and payment for lectures from ConMed Linvatec and Smith and Nephew. Lo is a consultant and receives royalties from Arthrex and Arthrocare and stock options from Tenet Medical. Chan, Fredine, Hiemstra, Hollinshead and Mohtadi received grants from Hip Hip Hooray, Calgary Orthopaedic Research and Education Fund and Calgary Regional Health Authority Research and Development Fund. Oddone Paolucci has no relevant financial disclosures. Sasyniuk is a consultant for ConMed Linvatec.