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Half of patients with posterior shoulder instability were successfully treated nonoperatively for 1 year
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SAN DIEGO — Among patients with posterior shoulder instability who had nonoperative management for at least 1 year, 40% of the patients will require surgery within 10 years, according to long-term study results presented here.
“When defining the rate of delayed surgery, the number of patients who were successfully treated non-operatively for 1 year was 53%; 40% of those converted to surgery at 10 years. The number of successfully treated nonoperatively at 10 years was 32%. These are the two take-home numbers — half of patients were treated successfully at 1 year, a third at 10 years,” Christopher L. Camp, MD, said at the American Orthopaedic Society for Sports Medicine Annual Meeting.
In the population-based, retrospective cohort study using the Rochester Epidemiology Project, Camp and colleagues studied the frequency and factors predictive for late surgical intervention of symptomatic posterior shoulder instability. Follow-up was 14 years, with a minimum of 5-years follow-up.
Overall, 115 patients who had new-onset posterior shoulder instability between January 1994 and July 2012 and had confirmatory imaging were studied. Of those patients, 54 underwent surgery during the first year and 61 patients were treated nonoperatively for at least 1 year after diagnosis. Of these 61 patients, 24 patients had surgery for symptomatic posterior shoulder instability within 10 years after initial diagnosis and 37 patients did not require surgery, which represented 32% of the entire cohort with posterior shoulder instability, he said.
Gender, occupation, age, smoking status, diabetes, number of dislocations and sports played were not predictive of conversion to surgery. However, he said increased BMI was predictive for late conversion to surgery. Camp said within 5 years of diagnosis for patients with BMI greater than 35 kg/m2, 67% required surgery. Within 10 years, 100% of patients with BMI greater than 35 kg/m2 required surgery. The researchers also found patients who underwent surgery were at an increased risk for radiographic progression of osteoarthritis. – by Kristine Houck, MA, ELS
Reference:
Woodmass JM, et al. Paper 143. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 5-8, 2018; San Diego.
Disclosure: Camp reports no relevant financial disclosures.