Alternatives to shoulder replacement

We do a lot of research in our clinic, one topic we research often is shoulder osteoarthritis. It truly amazes me how many new studies there are on the problems of shoulder replacement and fixing a failed replacement.

Here is a February 2018 study from a Swedish research team. It appears in the journal Acta orthopaedica and discusses shoulder hemiarthroplasty.

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Shoulder Labrum tear | Labral repair versus biceps tenodesis

A January 2018 study from the Hospital of Special Surgery and the Mayo Clinic discussed the diagnostic and treatment challenges presented by injuries to the biceps and superior labral complex.

Nonoperative management, even in overhead athletes, has demonstrated relatively good outcomes, while operative outcomes have yielded mixed results. The surgeon must take into account a number of variables when choosing the appropriate surgical procedure: labral repair versus biceps tenodesis. Rehabilitation, either as nonoperative management or as a postoperative protocol, should focus on restoring glenohumeral and scapulothoracic strength, endurance, and full, pain-free range of motion, while correcting any deficiencies in balance or rhythm throughout the overhead motion.”(1)

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Avoiding shoulder replacement surgery

Here is a new report from doctors at the Mayo Clinic. It was published in the Journal of shoulder and elbow surgery December 18, 2017 edition. Here are the highlights:

  • 42 patients who had shoulder replacement, two patients had both shoulders replaced. Minimum 10 year follow up. Goal: Long-term assessment of shoulder replacement
  • Studies have demonstrated mixed results after humeral head replacement for osteoarthritis at short- and medium-term follow-up intervals.
  • Some patients experienced significant pain relief postoperatively that was maintained during the long-term follow-up
  • 11 patients more than 25% of the study group reported persistent moderate or severe pain minimum ten years out
  • Ten of 44 (22.7%) shoulders underwent revision surgery, predominantly for glenoid arthrosis (arthritis) (n = 9).
  • In the 25 shoulders with 5 years of radiographic follow-up, patients demonstrated moderate to severe glenoid erosion in 50% at 5 years, which increased to 59% at 15 years and 88% at 20 years.

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Tennis players have overexpectation of what shoulder surgery can do

A large research team from Stanford University, University of Auckland, the Women’s Tennis Association Tour, among others, working in conjunction in a recent study say:

“In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations.” (more…)

Shoulder Impingement: Surgery often not the answer

Research in the clinical journal of sports medicine suggests that surgical interventions for subacromial impingement syndrome do not reveal one surgical technique to be better than another, nor do they show that surgery is superior in any way to conservative interventions.1

Further data in the medical journal Arthroscopy shows, when young athletes have arthroscopic stabilization surgery, it must be emphasized to the patients and their families that the recurrence rate following arthroscopic procedures is higher in young people than in the adult population.2

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Chronic shoulder instability and disclocation

Traumatic shoulder dislocation is a frequent injury in the sports population. An acute shoulder dislocation often means a one time traumatic episode, whereas chronic shoulder instability indicates frequent dislocations.

Following an initial shoulder dislocation, doctors will debate whether or not to perform a surgery to prevent recurrence. If the patient in under 30 years of age, shoulder surgery is typically recommended because younger athletes are much more prone to repeated dislocations than older athletes.

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