Before you have Shoulder Replacement
Doctors are saying that if you had a surgery that failed to fix your shoulder pain – it is not recommended that you get a second surgery to fix the first one because 36% of those surgeries fail too. This is why patients are looking for shoulder replacement alternatives
A new study from Canada reveals what patients consider good “out of pocket” expenses in regard to their shoulder treatment
Shoulder replacement is a common treatment to decrease pain and improve shoulder function in patients with severe osteoarthritis. In Canada, patients requiring this procedure often wait a year or more. In this study Canadian investigators administered a discrete choice experiment among patients with end stage shoulder osteoarthritis currently waiting for shoulder replacement. Respondents were presented with 14 different choice sets, each with 3 options, and they were asked to choose their preferred scenario.
Sixty-two respondents completed the questionnaire. Three of the 4 attributes significantly influenced treatment preferences.
- Respondents had a strong preference for an experienced surgeon
- While reductions in travel time needed to get to the surgeon and the wait time to get the surgery were less important.
- Respondents were found to be strongly averse to surgical treatment by a less experienced surgeon and to paying out-of-pocket for their surgical treatment for a lesser surgeon
- Bottom line: The patients will pay higher amounts for treatment by an experienced surgeon.1
Patents read research on the problems of shoulder surgery
Here is another new study on why patients will pay more for the best surgeon OR why they will explore non-surgical treatment options.
Researchers say the number of shoulder replacements being performed has increased exponentially in recent years, with a corresponding increase in the number of revision procedures. The need for a second surgery to fix the first one.
- In patients surveyed for this study: 21.6% (8/37) required reoperation for postoperative complications.
- Overall, 54% of patients (20/37) suffered from intra- or postoperative complications.
CONCLUSION: Shoulder implant replacement improved function in the present series, but with a high rate of complications and reoperations.2
This of course will throw a big concern for patients out the window – that of shoulder replacement recovery time – complications are often lengthy and sometimes never go away.
Shoulder replacement revision procedures
Doctors are saying that if you had a surgery that failed to fix your shoulder pain – it is not recommended that you get a second surgery to fix the first one because 36% of those surgeries fail too.3
- Shoulder replacement infection: In another study, doctors say that one of the greatest risk factors for infection after shoulder replacement were history of a prior failed shoulder surgery. So replacing the shoulder in an attempt to fix the first shoulder surgery had high risk of infection.4
- Another study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or ball replacement and compared them with those of older patients undergoing the same procedure. While reverse total shoulder arthroplasty is effective in reducing pain and improving function after failed arthroplasty in young patients, complication rates are high and expectations should be managed appropriately. Subjective outcome scores are worse for older patients.5
The most common causes of revision surgery after reverse total shoulder arthroplasty (RTSA) are:
- prosthetic instability (38%),
- infection (22%),
- humeral problems (21%) including loosening, unscrewing and fracture,
- and, lastly, problems of polyethylene glenoid loosening (13%).
Complications leading to reoperation are often multiple and underestimated.
It is not uncommon for patients to be reoperated several times due to the persistence of the same complication, failure to diagnose associated complications, or onset of an additional complication.5
Doctors at the University of Washington sum up shoulder failure surgery as: “…surgery has failed when it does not achieve the expectations of the patient and the surgeon. Failure can result from stiffness, weakness, instability, pain or failure to heal as well as from complications such as infection or nerve injury
Every surgery has a risk of failure whether it is an operation for dislocation, rotator cuff tear, arthritis or fracture. Because fracture fixation, Bankart repairs, rotator cuff repairs, shoulder joint replacements and reverse total shoulders are performed commonly, a substantial number of patients have experienced these failures.”
We frequently see patients who have had surgery for shoulder pain, but are subsequently left with chronic pain after surgery. The surgery will sometimes lead to rapid shoulder deterioration and subsequent arthritis. At some time then in the future shoulder replacement will be recommended.
Here is a case history of a patient who came to Caring Medical. The patient had extensive shoulder surgery. Seemingly, the surgeon tried to “fix” everything he thought was damaged enough to cause pain. The surgery went as planned, no complications, and the surgeon accomplished everything he set out to do. Two years following the surgery the patient came to our office, still in pain. How could this be? Let’s look exactly what was done.
The patient had an an arthroscopic procedure for:
- partial thickness rotator cuff tear, Type I (least severe),
- a labral tear,
- grade III to IV (nearly most or most severe) chondromalacia of glenohumeral joint and
- subacromial bursitis.
The labrum is a lip of cartilage that helps keep the end of the humerus in the shallow socket (glenoid). Chondromalacia is the degeneration of the cartilage inside the joint. Bursitis refers to the bursa, one of the fluid-filled sacks that provide cushioning in joints.
In the procedure the surgeon debrided the labral tear and the rotator cuff tear. Then, where the chondromalacia was most severe, he performed a chondroplasty. This consists of scraping the damaged cartilage which covers the surface of the bone in hopes of having healthy cartilage grow back. He scraped both the humeral head and the glenoid. He then performed a bursectomy, removing the inflamed bursa. This is fairly typical what we see in an arthroscopy report of the shoulder.
The patient expressed a desire to return to tennis as a key to surgery outcome,and surgery did not help him with this, and he was left with chronic pain. The patient went on to receive Prolotherapy treatment.
Alternatives to shoulder replacement surgery
In regenerative injection techniques like Prolotherapy, Platelet Rich Plasma Therapy or Stem Cell Prolotherapy, the goal is always to preserve and regenerate these cushions and connective tissues rather than remove them. (See cartilage repair). It makes our job here at Caring Medical a little more difficult when treating a patient who has had an extensive procedure, but it is still possible to achieve healing after surgery.
Can J Surg. 2016 Apr;59(2):107-12.
2. Antoni M, Barthoulot M, Kempf JF, Clavert P. Revisions of total shoulder arthroplasty: Clinical results and complications of various modalities. Orthop Traumatol Surg Res. 2016 Mar 8. pii: S1877-0568(16)00051-7. doi: 10.1016/j.otsr.2016.01.009. [Epub ahead of print]
3. De Giorgi S, Garofalo R, Tafuri S, Cesari E, Rose GD, Castagna A. Can arthroscopic revision surgery for shoulder instability be a fair option? Muscles Ligaments Tendons J. 2014 Jul 14;4(2):226-31. eCollection 2014.
4. Morris BJ, O’Connor DP, Torres D. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014 Aug 26. pii: S1058-2746(14)00281-X. doi: 10.1016/j.jse.2014.05.020. [Epub ahead of print]
5. Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJ. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger. J Shoulder Elbow Surg. 2014 Jul;23(7):1036-42. doi: 10.1016/j.jse.2014.02.019.
6. Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016 Feb 12. pii: S1877-0568(15)00349-7. doi: 10.1016/j.otsr.2015.06.031. [Epub ahead of print]