Who Will Develop Glenohumeral Arthritis After Arthroscopic Posterior Stabilization?
In a study presented at the American Orthopedic Society for Sports Medicine-Arthroscopy Association of North America Combined 2021 Annual Meeting, about 12% of patients who underwent shoulder stabilization surgery developed arthritis in the shoulder joint.
Why those particular patients progressed to glenohumeral arthritis during the study period and others did not remains unclear, although age and glenoid bone loss may play a role.
“While arthroscopic stabilization for posterior glenohumeral instability has shown excellent success preventing recurrent instability and allowing return to sport, eventual progression to glenohumeral arthritis remains a concern in these patients,” said Bobby Yow, MD, from Walter Reed National Military Medical Center in Bethesda, Maryland.
Dr. Yow and colleagues sought to evaluate the rate of progression to glenohumeral arthritis and identify potential risk factors after arthroscopic posterior stabilization in a young, high-demand population. They enrolled in their study 110 active duty service members (mean age 23.9; SD 6.71) who were identified in the Military Heath System (MHS) as undergoing primary arthroscopic surgical stabilization for posterior shoulder instability and who had postoperative imaging or medical records available over a 12-year period (January 2004 through September 2016).
The researchers found that 12.7% (14/110) of these patients developed glenohumeral arthritis during the study period. The median time to diagnosis of arthritis was 7 years, and the median follow-up time was 8.1 years (IQR 5.8).
The overall incidence of glenohumeral arthritis was 1.7 per 100 person-years (95% CI 0.92, 2.81). Ten-year GHOA-free survival was 84.0% (95% CI 75.3, 93.8). Hazard ratios (95% CIs) estimated from separate Cox regression models of the development of glenohumeral arthritis were 1.45 (0.76, 2.74) for age in years (per SD) and 0.87 (0.74 to 1.03) for glenoid bone loss.
“No previous study has reported the incidence and risk factors for glenohumeral arthritis after arthroscopic surgical stabilization for posterior shoulder instability,” Dr. Yow said. “Alhough no risk factors were found amongst the cohort, the hypothesized higher risk with increasing age at index procedure and near significant confidence interval for glenoid bone loss warrants further evaluation in larger cohorts not limited to active-duty service members.”
Dr. Yow said that the study findings may help guide clinical decision making and chronicity of treatment for patients presenting with posterior shoulder instability.