Speaker: Risk of recurrence important to assess in first-time shoulder dislocation
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SAN FRANCISCO — Surgeons should treat patients with first-time shoulder dislocations critically by identifying risk of recurrence, the risk of delaying surgery and the relative success and risk of surgery, according to a presenter here.
Previously published literature has shown factors that increase a patient’s risk of recurrence include age, male sex and hyperlaxity, while greater tuberosity has been found to be a protective factor, according to Lo.
“What other factors could you consider? Well, competitive sports, contact sports, blood and bone loss, and humeral bone loss have all been mentioned,” Ian K.Y. Lo, MD, FRCSC, FAANA, said in his presentation at the Arthroscopy Association of North America Annual Meeting.
Lo said that when surgery is delayed, patients can experience increased pathology, including increased soft tissue damage and changes in bone pathology.
“The other problem is that we know that when you operate on patients, primary vs. recurrent instability, the outcomes are worse as well,” Lo said. “There are only three comparative studies out there, but all show increased failure rate when you look at recurrent vs. primary dislocators.”
He added recurrent instability also increases the risk of osteoarthritis.
“The most important thing is to get stability,” Lo said. “Even one recurrence can lead to an increase in your osteoarthritis at long-term follow-up.”
When it comes to surgery, Lo noted previously published research showed patients younger than 30 years of age had a better recurrence rate and better Western Ontario Shoulder Instability Index scores when undergoing surgery vs. those treated with conservative management.
“In fact, many studies have replicated this as well, both in the general population and the military population,” Lo said. “You can see here [there are] 10 prospective trials, 500 patients [and] the mean age is only 21 [years], so that is important to note. The vast majority of patients are male. You can see the recurrence rate of further surgery is lower and return to sport is better, as well, and the complication rate for Bankart repair is low. Other than recurrence rate, overall complication rate is only 1.6% of relatively minor complications.”
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Lo IKY. First-time dislocators: Who should get surgery? Presented at: Arthroscopy Association of North America Annual Meeting. May 19-21, 2022; San Francisco.
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