Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Oh I am so disappointed that my shoulder surgery for a chronic dislocations didn't hold. If I have it done again, what are my chances it will take the second time? Should I even bother?

Answer:

When the shoulder dislocates repeatedly, it's time to get some serious help. That's when the surgeon steps in and provides the kind of stabilization procedure you had. Special suture anchors are used to repair damage to the soft tissue. The surgeon can use either an open incision approach or an arthroscopic method to accomplish the task. Sometimes the stabilization doesn't hold and the shoulder re-dislocates. Once again, the surgeon can go back in and use surgical means to restabilize the joint. This is the decision point at which you find yourself right now. Invariably, the question comes up whether the second surgery will do the trick (or not). No one likes to face a revision operation for something they hoped would be taken care of the first time around. Various studies have been published on the rates of success/failure for arthroscopic versus open stabilization. The rates of failure requiring a revision operation are fairly even between the two different approaches. So the next question is: how do the results compare between the initial stabilization surgery and the revision (second) surgery? In a recent study from Germany, this comparison was made just for patients who were treated using the arthroscopic approach. The same technique using suture anchors was used for both sets of patients for a clear comparison. And patients were "matched" between the groups so that their ages, sex (male versus female), and hand dominance (right-handed versus left-handed) were the same between the two groups. Everyone was followed for at least two years so the data collected reflect mid-range results. Patients will be followed further in order to gather long-term results as well. But for now, here's what they found. First of all, the patients who had a longer period of time with more recurrent dislocations before the initial stabilization surgery were the most likely to require further surgical procedures. Four other differences were seen from the revision group when compared to the group who only had the initial stabilization procedure. Shoulder function was reduced in the revision group. Return to sport or work at the same level as before the first surgery was a bigger problem for the revision group. Many had to reduce their work/play, change sport, or even quit sports involvement. Shoulder fatigue with everyday activities like writing or raising the arms overhead was reported more often in the revision group. A sudden, unguarded movement (e.g., losing balance) requiring the arms to respond quickly created problems for the revision group. The revision group was afraid of falling, especially if it meant a fall onto the involved shoulder. And finally, the revision group was unable to maintain their preferred level of fitness. You probably get the picture the surgeons saw: outcomes after revision (salvage) surgery for recurrent shoulder instability just aren't as good as results for patients who only need one stabilization procedure. But some of those patients did have a good result. So perhaps there are individual patient factors that contribute to a successful outcome. Your surgeon will be the best one to advise you on this one -- your age, activity level, and type and severity of soft tissue damage are likely important factors that could tip the scales in your favor for a good result. David Krueger, et al. Subjective and Objective Outcome After Revision Arthroscopic Stabilization for Recurrent Anterior Instability Versus Shouler Stabilization. In The American Journal of Sports Medicine. January 2011. Vol. 39. No. 1. Pp. 71-77.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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