Arthroscopic stabilization leads as EDS shoulder instability procedure
Less than 5% of EDS, JHS patients in database elected to have surgery
A procedure called arthroscopic stabilization is the most common surgical treatment for shoulder joint instability in people Ehlers-Danlos syndrome (EDS) and joint hypermobile syndrome (JHS). Open surgeries are less commonly performed.
Both EDS and JHS affect the connective tissue and are marked by hypermobile joints, meaning they move more widely than normal, which leads to pain and often to dislocations, including in the shoulder.
“The wide spectrum of pathology [disease] and presentations of shoulder instability, as well as the range of surgical options, reiterates the need for careful consideration of surgical and patient factors before proceeding with surgery,” the researchers wrote. The study, “Trends in surgical procedures for shoulder instability among patients with Ehlers-Danlos syndrome or joint hypermobility syndrome,” was published in JSES International.
People with EDS, JHS, or other conditions that feature shoulder instability commonly have physical therapy for months before considering surgery.
Here, a team led by researchers at The Johns Hopkins University School of Medicine evaluated the surgical procedures commonly used for shoulder instability with EDS or JHS that drew on a healthcare database that contained U.S. all-payer claims data between 2010 and 2020.
Choosing surgery for EDS, JHS
Among 109,274 people with EDS, 3.4% had shoulder stabilization procedures. A smaller percentage (0.8%) of the 453,885 JHS patients underwent such procedures. In both diseases, females accounted for the majority of patients undergoing the procedures (83% in EDS, 77% in JHS). A higher proportion of patients were younger than 25 (more than 40% in both diseases).
The predominant surgical treatment was arthroscopic stabilization, which was used in 78% of EDS patients and 83% of those with JHS. In the procedure, a surgeon inserts a thin device into a small incision to repair damaged tissues.
Open surgical procedures were less common. They included an open capsulolabral shift, wherein the joint capsule that is made of connective tissue is tightened, and Latarjet coracoid transfer, where a piece of bone from the shoulder blade is transferred to the front of the shoulder socket. An open capsulolabral repair, wherein the joint capsule is reconstructed using other tissues from the patient or a donor, were also performed.
Among people with EDS, there were no significant changes over time in the proportion of patients treated with each procedure, but arthroscopic stabilization surgery increased significantly, by 0.7% annually, among JHS patients.
The proportion of EDS patients younger than 25 who had shoulder stabilization procedures decreased by almost 5% annually, but increased by 4.4% per year in those between ages 25-35. The proportion of women with EDS who needed these treatments increased by 1.1% a year. Surgical procedures decreased in JHS patients older than 35 (4.6% per year). Younger patients showed annual increases, however.
“The observed increase in the age of EDS patients suggests advancements in nonoperative interventions and preference for exhausting nonsurgical options before pursuing surgery,” the researchers wrote. “Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies.”
About the Author
