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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)
 

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 HCA International Health.

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 MHCA International Health.

More Articles by Dr. Routman

Why See a Shoulder Specialist?

Dr. Scott Humphrey MD discusses the importance of choosing an orthopedic surgeon that specializes in shoulders when you are suffering from shoulder disease or injuries. The article will also give you important information about what makes a doctor a shoulder specialist, and how to make the most out of you visit with the specialist. Read the entire article at Dr Humphrey's website..

 
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