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For the Most Common Shoulder Problems, Delay in Surgical Evaluation May Make the Situation Worse
Some patients with shoulder disorders have been encouraged to "live with it" as
long as possible and avoid surgical treatment because of a perceived unreliability of
surgery. Years ago, this may have been good advice for certain diagnoses - but for the
majority of shoulder disorders we are now able to reproducibly provide substantive
improvement for our patients with surgery. In fact, prolonged non-surgical treatment for
some of the most common shoulder problems (rotator cuff tears and osteoarthritis) can
allow a correctible shoulder problem to become harder to repair, or possibly go beyond
repairability.
Read this detailed, illustrated article to find out more.
Replacing Shoulder No Riskier Than Replacing Other Joints
According to Science Daily, researchers at Johns Hopkins have found that total shoulder
replacements are as safe as swapping out hips and knees. Perhaps surprisingly, the
investigators have determined that patients who undergo shoulder arthroplasty to
relieve chronic and significant pain can expect significantly fewer complications,
much shorter hospital stays, and lower costs than patients undergoing hip or knee
replacement.
The Hopkins research team, led by Edward McFarland, M.D., director of the Division
of Adult Orthopedics at The Johns Hopkins Hospital, analyzed anonymous patient information
provided by the Maryland Health Services Cost Review Commission, the state’s
hospital rate-regulator. The team examined all Maryland arthroplasties done to alleviate
osteoarthritis pain between 1994 and 2001, including 15,414 hip surgeries, 34,471
knee operations, and 625 shoulder procedures.
McFarland, commenting in the news release, stated, “After looking at how all
these patients fared, we concluded that, comparatively, total shoulder surgery is
just as safe and effective as other types of arthroplasties. Lower numbers of shoulder
procedures done both regionally and nationally may indicate that many people live
with shoulder pain because they fear that the corrective surgery is too risky or
costs more than similar procedures. But we have found that this is just not true.”
They determined that participants who had shoulder surgery had far fewer in-hospital
post-surgical complications (7.5%) compared with those patients who had their hips
and knees replaced (15.5% and 14.7%, respectively). McFarland’s team also
found that the average time a person remained hospitalized after the surgery was
shortest for those recovering from shoulder procedures (just 2.42 days for shoulder
patients, versus more than four days for both the hip and knee equivalents).
An added benefit, according to McFarland, is that shoulder arthroplasty is also
less expensive. A shoulder replacement’s total costs, on average, are $10,351;
whereas hip replacement surgery averages $15,442, and knee arthroplasty, $14,674.
During the study period, no fatalities were associated with shoulder replacement,
but there were 27 deaths among hip replacement patients and 54 among those having
knee replacements. McFarland indicated that, because the number of shoulder surgeries
actually performed was small, the mortality rates for the procedure were not statistically
different from the other forms of arthroplasty. It was determined, however, that
having no deaths attributed to total shoulder replacement in the group of patients
studied did add “clinical significance” to the idea that shoulder surgery
is relatively safer. The team hypothesizes that the higher number of deaths related
to hip and knee procedures may be related to repeat surgeries stemming from postoperative
complications during the same hospitalization, a need for blood transfusions, or
extended intensive care stays.
As stated in the article, McFarland says that most patients who are candidates for
total shoulder replacement surgery are “at the end of their rope” trying
to manage chronic pain and disability with drugs. “Ninety-nine percent of
the people who have a shoulder replacement for arthritis get pain relief and say
that they wish they had done it sooner,” says McFarland. “This study
indicates there may be little reason to wait.” -- EH (March 27, 2007)
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A New Shoulder Prosthesis That Is More Effective
Dr. Howard D. Routman discusses a new, more effective shoulder replacement prosthesis
in this
article posted on Miami Health International.
Dr. Routman states: “These shoulder prostheses are a great advance that has
been achieved, particularly for patients who not only suffer severe shoulder arthritis,
but also have irreparable rotator cuff damage".
He goes on to explain: "The benefits are greater, greater movement is achieved
with less pain, because in addition to correcting the cartilage problem, it also
corrects the muscle problem. Furthermore, this procedure makes it possible to replace
prior failed prosthetic implants. The new prostheses are also being tried out on
older patients who have suffered traumatic injuries."
Read the
full article at Miami Health International.
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