Nonoperative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis

Jarret M. Woodmass, Julia Lee, Nick R. Johnson, Isabella T. Wu, Christopher L. Camp, Diane L. Dahm, Aaron Krych

Research output: Contribution to journalArticle

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Abstract

Purpose: To (1) define the rate of delayed surgery, between 1 and 10 years after injury, in a population-based study of patients with posterior shoulder instability (PSI), (2) evaluate predictive factors associated with delayed repair, and (3) identify differences between the nonoperative and operative groups at long-term follow-up. Methods: A population-based retrospectively reviewed study of all patients with PSI from January 1, 1994, to December 31, 2015, was performed. Inclusion required a clinical diagnosis of PSI combined with supporting imaging. Complete medical records were reviewed for 2,091 potential cases. Kaplan-Meier estimates were used to calculate survival. Landmark survival analysis was performed to identify predictors of conversion to surgery. Results: The study included 143 patients with PSI, 79 of whom were managed nonoperatively for at least 1 year after diagnosis. After the first year, survival free of surgery was 78.3% at 1 year, 63.1% at 5 years, and 51.5% at 10 years. There was a trend toward increased surgery in patients with a body mass index > 35 (P = .10; hazard ratio = 2.32; confidence interval, 0.8-6.8). Nonthrowing athletes (including contact/weight-lifting athletes) showed a trend toward an increased risk for surgery (P = .07). Patients who underwent surgery were significantly more likely to have progression in arthritis (P = .02; hazard ratio = 4.0; confidence interval, 1.2-13.2). Conclusions: Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Overall, long-term follow-up demonstrates that 46% of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70% of patients diagnosed with PSI go on to surgical intervention. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up. Level of Evidence: Level III, cohort study.

Original languageEnglish (US)
Pages (from-to)1964-1970
Number of pages7
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2019

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Survival
Athletes
Arthritis
Weight Lifting
Confidence Intervals
Kaplan-Meier Estimate
Survival Analysis
Population
Medical Records
Body Mass Index
Cohort Studies
Wounds and Injuries

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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Nonoperative Management of Posterior Shoulder Instability : An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis. / Woodmass, Jarret M.; Lee, Julia; Johnson, Nick R.; Wu, Isabella T.; Camp, Christopher L.; Dahm, Diane L.; Krych, Aaron.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 35, No. 7, 01.07.2019, p. 1964-1970.

Research output: Contribution to journalArticle

Woodmass, Jarret M. ; Lee, Julia ; Johnson, Nick R. ; Wu, Isabella T. ; Camp, Christopher L. ; Dahm, Diane L. ; Krych, Aaron. / Nonoperative Management of Posterior Shoulder Instability : An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2019 ; Vol. 35, No. 7. pp. 1964-1970.
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abstract = "Purpose: To (1) define the rate of delayed surgery, between 1 and 10 years after injury, in a population-based study of patients with posterior shoulder instability (PSI), (2) evaluate predictive factors associated with delayed repair, and (3) identify differences between the nonoperative and operative groups at long-term follow-up. Methods: A population-based retrospectively reviewed study of all patients with PSI from January 1, 1994, to December 31, 2015, was performed. Inclusion required a clinical diagnosis of PSI combined with supporting imaging. Complete medical records were reviewed for 2,091 potential cases. Kaplan-Meier estimates were used to calculate survival. Landmark survival analysis was performed to identify predictors of conversion to surgery. Results: The study included 143 patients with PSI, 79 of whom were managed nonoperatively for at least 1 year after diagnosis. After the first year, survival free of surgery was 78.3{\%} at 1 year, 63.1{\%} at 5 years, and 51.5{\%} at 10 years. There was a trend toward increased surgery in patients with a body mass index > 35 (P = .10; hazard ratio = 2.32; confidence interval, 0.8-6.8). Nonthrowing athletes (including contact/weight-lifting athletes) showed a trend toward an increased risk for surgery (P = .07). Patients who underwent surgery were significantly more likely to have progression in arthritis (P = .02; hazard ratio = 4.0; confidence interval, 1.2-13.2). Conclusions: Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Overall, long-term follow-up demonstrates that 46{\%} of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70{\%} of patients diagnosed with PSI go on to surgical intervention. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up. Level of Evidence: Level III, cohort study.",
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AU - Wu, Isabella T.

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