2023 ISAKOS Biennial Congress ePoster
Recurrent Shoulder Dislocations Prior to Labral Repair is Associated with Increased Risk of Reoperation for Instability: A Large Matched Cohort Insurance Database Analysis
Elyse Berlinberg, BS, New York, NY UNITED STATES
Melissa Song, BS, New York, NY UNITED STATES
Harsh Patel, BS, New Brunswick, New Jersey UNITED STATES
Vikranth R Mirle, BS, Chicago, IL UNITED STATES
Randy Mascarenhas, MD, FRCSC, Winnipeg, MB CANADA
Brian Forsythe, MD, Chicago, IL UNITED STATES
Rush University Medical Center, Chicago, IL, UNITED STATES
FDA Status Not Applicable
Summary
Study of large insurance database cohort demonstrates that patients with a history of multiple dislocations are significantly more likely to require revision stabilization surgery and closed reduction suggesting early surgical intervention is warranted.
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Abstract
Introduction
Shoulder instability is known to lead to increased recurrence with each dislocation prior to stabilization procedures. The extent to which multiple shoulder dislocations increase the risk of recurrent instability following surgery in a large population is not known.
Methods
A large insurance database was queried for patients with shoulder stabilization for surgery between 2010-2018. The study population was stratified by single dislocation versus multiple dislocations before surgery. Groups were matched by surgery type, Charlson Comorbidity Index, age, and gender. The primary outcome was revision shoulder instability surgery; other outcomes included postoperative closed reduction of the shoulder, ED visits, readmissions, and medical complications.
Results
Baseline demographics were similar between groups (N=161 per group). Overall, 21 patients (13.0%) with a single dislocation and 47 patients (29.2%) with multiple dislocations had subsequent revision surgery (OR-2.75, P=0.0006). Twelve patients (7.5%) with a single dislocation and 42 patients (26.1%) with multiple dislocations required a closed reduction postoperatively (OR = 4.38, P<0.0001). An increasing number of dislocations was associated with greater risk of postoperative dislocation requiring closed reduction (OR = 1.05, 95% CI 1.04-1.07, P<0.0001) and increased risk of revision (OR = 1.03, 95% CI 1.02-1.05, P<0.0001). There were no differences in rates of manipulation under anesthesia (P=0.62), readmission (P=0.80), or complications (P>0.99). Significant predictors of revision for instability included open Latarjet procedure (adj-OR=10.39, P=0.03), arthroscopic capsulorrhaphy (adj-OR=7.53, P=0.03), and history of multiple shoulder dislocations (adj-OR=2.92, P=0.0003).
Conclusions
Compared to patients with a single shoulder dislocation, those with multiple dislocations are twice as likely to require revision surgery and 3 times as likely to require a postoperative closed reduction. An increasing number of dislocations prior to a stabilization procedure is associated with a greater risk of postoperative instability requiring closed reduction or revision. Overall, patients undergoing labral repair may benefit from earlier surgical intervention.