Hypermobility doesn’t affect outcomes of certain surgeries: Study
Worse outcomes seen after ankle surgeries for patients with hypermobile joints
People with Ehlers-Danlos syndrome (EDS) and hypermobile joints generally have similar or slightly worse outcomes after surgery for shoulder, knee, and hip joint instability, compared with those without hypermobility, according to a review study.
However, patients with hypermobility conditions (when joints move past the normal range of motion) have consistently worse outcomes after ankle surgeries, both in patient-reported outcomes and recurrence of joint instability. This was also observed after certain knee surgeries.
The study, “Outcomes after Surgical Management of Large Joint Manifestations in Ehlers Danlos Syndrome and Hypermobility Conditions in Sports Medicine: a Systematic Review,” was published in Current Reviews in Musculoskeletal Medicine.
EDS and joint hypermobility are inherited disorders affecting the connective tissues, which provide structure to joints and other tissues and organs. These conditions are characterized by excessive joint mobility and tissue fragility, with many patients reporting symptoms such as joint pain and instability.
Large joints susceptible to dislocations, instability, inflammation
Large joints, including shoulders, elbows, wrists, hips, knees, and ankles, are particularly susceptible to dislocations, instability, and inflammation. While various therapeutic approaches exist, ranging from physical therapy to surgical procedures, “there remains considerable uncertainty regarding optimal treatment strategies,” the researchers wrote.
To know more, a team in Canada and Ireland conducted a systematic review of studies on surgical treatments of major joints in adolescents and adults undergoing sports medicine procedures. A total of 38 studies, including 144,609 patients, were analyzed.
Among all studies, patients were a mean age of 26.7 years and most commonly female (63.1%). Overall, 144,860 joints were treated, with the vast majority being shoulders (97.1%).
Six studies analyzed surgical management of glenohumeral (shoulder) instability in 140,616 patients. Hypermobility was detected in 804 patients from the five studies reporting on hypermobility, including 11 with EDS, 37 with generalized hypermobility, and 756 who were jointly classified as having EDS or generalized hypermobility.
Among people with hypermobility, 112 underwent open procedures. There were 617 arthroscopy procedures, a type of minimally invasive surgery. Forty patients with hypermobility (5%) experienced a repeat dislocation. Results of one study showed no differences in the rate of joint redislocations between patients who were hypermobile and those who weren’t, two years after surgery.
In seven studies, the most commonly reported surgical procedure in the hips was arthroscopy to repair hip impingement, when the femoral head (ball of the hip) pinches up against the hip socket, causing damage and pain. Among 1,932 patients, 23.7% had generalized hypermobility and 0.72% had EDS.
Four studies including 383 hypermobile patients reported on additional surgical procedures, most commonly to reshape the head of the femur or the hip socket. The outcomes seen in patients, regardless of whether they were hypermobile, were comparable in terms of improvement in patient-reported outcomes and failure rates.
Six studies included 470 patients (516 knees), 240 of them with EDS, who required surgery to treat instability in the patellofemoral joint of the knee. In most cases, surgery involved stabilization, and 16% of the hypermobile knees experienced a repeat dislocation after surgery. Hypermobility did not influence dislocation rates in two studies.
Six studies including 819 patients, 337 with generalized hypermobility and one with EDS, reported on surgery to reconstruct the anterior cruciate ligament that stabilizes the knee joint, connecting the thigh and lower leg bones. In this case, one study reported that hypermobile patients were more likely to experience recurrence (14% vs. 2.9%).
Ankle surgeries were reported in a total of nine studies enrolling 679 patients. There were 320 patients with joint hypermobility among the eight studies with hypermobility data. They described procedures to treat chronic lateral ankle stability, which usually involved a combination of open and arthroscopic approaches. Surgical outcomes were significantly worse in people with hypermobility, including measures such as patient-reported outcomes and recurrent instability.
Elbow surgeries were described in three EDS patients with elbow instability. After surgery, these patients did not have instability and had a satisfactory range of motion.
“There was a low number of studies investigating the effect of hypermobility on patients with elbow, hand or wrist conditions,” the researchers wrote. As such, future studies are needed “to investigate the risk of hypermobility and how they affect non-surgical and surgical management of these conditions.”
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