Several factors increased risk of glenohumeral OA after arthroscopic Bankart repair
Results from the American Shoulder and Elbow Surgeons Annual Meeting showed risk factors for glenohumeral osteoarthritis after arthroscopic Bankart repair included patient age at index surgery, the number of anchors and revision surgery.
Jonathan F. Dickens, MD, and colleagues retrospectively analyzed postoperative imaging classification of OA, the number of anchors and the need for revision surgery among 287 patients who underwent arthroscopic Bankart repair.
“Glenohumeral OA was defined as the presence of any grade 1 to 4 OA determined by the Samilson and Prieto classification or no clinical and radiographic findings of OA on follow-up,” Dickens said in his presentation.
During the study period, 8% of shoulders developed glenohumeral OA, according to Dickens. He noted patents who developed glenohumeral OA were more likely to have an increased number of anchors. Dickens added 39% of patients with OA underwent revision surgery vs. 18% of patients without OA.
“We performed a Kaplan Meier survival curve [which was] used to examine the surgical features predictive of glenohumeral OA and then, based on this, developed a multivariate model of which revision surgery was the most predictive of future development of glenohumeral OA, with a hazard ratio of 2.83, followed by age and anchor number,” Dickens said.
Perspective
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Our understanding of arthroscopic stabilization procedures continues to evolve over time. The research presented by Jonathan F. Dickens, MD, and his co-authors at the ASES Annual Meeting and subsequent commentary highlight the significant factors that were associated with increased rates of glenohumeral arthritis in a young and high-demand population. The good news for readers was the overall low rate of glenohumeral OA in their population at 8%.
The concern is our understanding of the optimal anchor number in these procedures. Is less or more better? The results from Dickens suggested a higher rate of glenohumeral OA was associated with more anchors that were placed. Other studies have associated increased failure rates of stabilization procedures with fewer than four anchors, suggesting more anchors may be better. In addition, surgeons also must cautiously consider revision surgeries as these factors appear to increase a patient’s risk of glenohumeral OA. This association is due to increased dislocation rates or the other factors leading to failure of initial procedures.
Regardless, we as surgeons should take the time to educate our patients of their increased risk of OA in the setting of revision surgery and other associated factors such as younger age.
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Yow B, et al. Progression to glenohumeral arthritis after arthroscopic anterior stabilization in a young and high-demand population. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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