PhysioUpdate 19th July 2022


Shoulder surgery risks are low overall but risk of re-operation is significant: The BMJ study

The rates of serious complications associated with shoulder surgery are low, but one patient in 26 needs further surgery within a year, a study published in The BMJ today (7 June) suggests.

The use of arthroscopic surgery for shoulder and knee problems has increased rapidly over the past two decades. Common arthroscopic shoulder procedures include rotator cuff repair and frozen shoulder release, despite there being a paucity of accurate data on their risks.

To fill this knowledge gap, researchers used NHS hospital data for England to estimate the risks of complications within 90 days of the most common elective shoulder arthroscopy procedures, and re-operation within one year.

The use of arthroscopic surgery for shoulder and knee problems has risen rapidly

The paper's lead author is Jonathan Rees, a professor at the University of Oxford-based Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. The study was based on 288,250 arthroscopic shoulder procedures performed on 261,248 patients, who were aged 16 years and over, from 1 April 2009-31 March 2017. 

Serious adverse events needing inpatient care within 90 days of surgery were death, pulmonary embolism, pneumonia, heart attack, acute kidney injury, stroke, and urinary tract infection, and re-operations (including for deep infection) within one year.

The overall rate of complications within 90 days after arthroscopic shoulder surgery (including reoperation) was low at 1.2 per cent, with one patient in 81 at risk. Complication rates varied according to type of procedure, but these differences disappeared after accounting for age, sex and underlying conditions (comorbidities). The most common adverse event was pneumonia (one in 303 patients at risk), while pulmonary embolism was rare (one patient in 1,428).

Re-operation rates

One patient in 26 had a reoperation within one year, suggesting either an ineffective procedure or a complication. Reoperation due to infection was low (one in 1,111 patients) but was higher for rotator cuff repair (one in 526 patients). Particularly high reoperation rates were found after frozen shoulder release surgery, which probably highlights the poorly understood and unpredictable nature of this condition, note the researchers.

Over the study period, the number of arthroscopic shoulder procedures increased. However, subacromial decompression (surgery to treat shoulder impingement) operations decreased in number.

The findings suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year [Jonathan Rees et al.]

Cause not established

As the study was observational in nature, cause cannot be established, the researchers acknowledge. They did not capture complications that were mild enough to be treated in primary care settings. Nevertheless, the results are based on a large sample of population level data, ensuring more precise estimates of adverse events and reoperation rates.
 
Conclusion

In their conclusion, Professor Rees and his colleagues note: ‘The findings of this study suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year.'

They add: ‘As the numbers of other arthroscopic shoulder procedures continue to increase, this study provides real world generalisable estimates of serious adverse events and reoperation rates that should better inform surgeons and patients.'

Linked editorial

In a linked editorial, two orthopaedic surgeons note that safety data are welcome. But they pose the following question: do these procedures actually work?

Their editorial points out that recent trials have shone the light of science on arthroscopic shoulder procedures, typically finding most of them to be no better than non-surgical care for most patients. They note: ‘If arthroscopic shoulder surgery is to continue, high quality research must be done to find out which procedures are truly effective, and work according to patients and their conditions.’

In the meantime, they say this study ‘gives clinicians and patients confidence that if an arthroscopic shoulder procedure is known to be effective, it is likely to be safe as well’.

To read the full version of the paper, titled Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study, visit: https://www.bmj.com/content/378/bmj-2021-069901
To read the linked editorial, visit: https://www.bmj.com/content/378/bmj.o1571



Meagre evidence for continued use of hyaluronic acid injections for knee osteoarthritis: The BMJ

Researchers who reviewed more than 150 studies focusing on treating knee osteoarthritis with viscosupplementation have not endorsed its ‘broad use’. Their findings raise ethical issues about the continued use of the intervention in some countries.

The international research team – led by Tiago V Pereira, from the applied health research centre at the Li Ka Shing Knowledge Institute at St Michael’s Hospital in Toronto – published its findings in The BMJ today (7 July).

Dr Pereira and his colleagues found evidence that giving injections of hyaluronic acid (known as viscosupplementation) to treat knee osteoarthritis made almost no difference to pain and might raise the risk of adverse events.

Globally, an estimated 560 million people are living with knee osteoarthritis

Read More


Survey will shine a light on whether physios encourage patients to explore 'active travel' options
Pedal power: cycling with a toddler on board is an example of 'active travel' (stock image')

Read More


Want to receive newsletters?


FREE membership

Join Us

Sign up today for membership and get...

✓ Regular newsletters
✓ Full website access
✓ Sponsor Benefits

We’ll keep you connected so you’ll NEVER MISS AN UPDATE!

Join Here

Previous newsletters


PhysioUpdate Supplier News 4th August 2022
PhysioUpdate 2nd August 2022
PhysioUpdate 1st August 2022
PhysioUpdate 28th July 2022
PhysioUpdate 26th July 2022
PhysioUpdate 21st July 2022
PhysioUpdate 14th July 2022
PhysioUpdate 12th July 2022
PhysioUpdate Supplier News 7th July 2022
PhysioUpdate 5th July 2022
PhysioUpdate Supplier News 30th June 2022
PhysioUpdate 30th June 2022
PhysioUpdate Supplier News 23rd June 2022
PhysioUpdate 21st June 2022
PhysioUpdate 16th June 2022
PhysioUpdate Supplier News 14th June 2022
PhysioUpdate 7th June 2022
PhysioUpdate Supplier News 6th June 2022
PhysioUpdate 1st June 2022
PhysioUpdate 24th May 2022
PhysioUpdate 19th May 2022
PhysioUpdate 17th May 2022
PhysioUpdate 12th May 2022
PhysioUpdate 10th May 2022
PhysioUpdate Supplier News 5th May 2022
PhysioUpdate 3rd May 2022
PhysioUpdate Supplier News 28th April 2022
PhysioUpdate 26th April 2022
PhysioUpdate 19th April 2022
PhysioUpdate 14th April 2022
PhysioUpdate 12th April 2022
PhysioUpdate Supplier News 7th April 2022
PhysioUpdate 5th April 2022
PhysioUpdate 31st March 2022
PhysioUpdate 29th March 2022
PhysioUpdate 22nd March 2022
PhysioUpdate Supplier News 17th March 2022
PhysioUpdate 15th March 2022
PhysioUpdate 8th March 2022
PhysioUpdate 3rd March 2022
PhysioUpdate 1st March 2022
PhysioUpdate 22nd February 2022
PhysioUpdate 17th February 2022
PhysioUpdate 15th February 2022
PhysioUpdate Supplier News 10th February 2022
PhysioUpdate 8th February 2022
PhysioUpdate 3rd February 2022
PhysioUpdate 1st February 2022
PhysioUpdate 25th January 2022
PhysioUpdate Supplier News 20th January 2022
PhysioUpdate 18th January 2022
PhysioUpdate Supplier News 13th January 2022
PhysioUpdate 11th January 2022
PhysioUpdate 28th December 2021
PhysioUpdate 21st December 2021
PhysioUpdate Supplier News 16th December 2021
PhysioUpdate 14th December 2021
PhysioUpdate Supplier News 9th December 2021
PhysioUpdate 7th December 2021
PhysioUpdate 30th November 2021
PhysioUpdate Supplier News 25th November 2021
PhysioUpdate 23rd November 2021
PhysioUpdate Supplier News 18th November 2021
PhysioUpdate 16th November 2021
PhysioUpdate Supplier News 11th November 2021
PhysioUpdate 9th November 2021
PhysioUpdate 2nd November 2021
PhysioUpdate Supplier News 28th October 2021
PhysioUpdate 26th October 2021
PhysioUpdate Supplier News 21st October 2021
PhysioUpdate 19th October 2021
PhysioUpdate Supplier News 14th October 2021
PhysioUpdate 12th October 2021
PhysioUpdate Supplier News 7th October 2021
PhysioUpdate 5th October 2021
PhysioUpdate 28th September 2021
PhysioUpdate 21st September 2021
PhysioUpdate Supplier News 16th September 2021
PhysioUpdate 14th September 2021
PhysioUpdate Supplier News 9th September 2021
PhysioUpdate 7th September 2021
PhysioUpdate Supplier News 2nd September 2021
PhysioUpdate 24th August 2021
PhysioUpdate Supplier News 19th August 2021
PhysioUpdate 17th August 2021
PhysioUpdate 3rd August 2021
PhysioUpdate 27th July 2021
PhysioUpdate 20th July 2021
PhysioUpdate Supplier News 15th July 2021
PhysioUpdate 13th July 2021
PhysioUpdate 6th July 2021
PhysioUpdate 29th June 2021
PhysioUpdate 22nd June 2021
PhysioUpdate Suppliers News 18th June
PhysioUpdate 15th June 2021
PhysioUpdate 8th June 2021
PhysioUpdate 2nd June 2021
PhysioUpdate 4th May 2021
PhysioUpdate 27th April 2021
PhysioUpdate Supplier News 22nd April
PhysioUpdate 6th April 2021
PhysioUpdate 30th March 2021
PhysioUpdate Supplier News 25th March
PhysioUpdate 23rd March 2021
PhysioUpdate Supplier News 18th March 2021
PhysioUpdate 16th March 2021
PhysioUpdate 9th March 2021
PhysioUpdate 2nd March 2021
PhysioUpdate Supplier News 25th February
PhysioUpdate Supplier News 18th February
PhysioUpdate 16th February 2021
PhysioUpdate 2nd February 2021
PhysioUpdate Supplier News 21st January
PhysioUpdate 19th January 2021
PhysioUpdate 5th January 2021
PhysioUpdate 22nd December 2020
Industry News
9 December 2020
By using our site, you acknowledge that you have read and understand our Cookie Policy and Privacy Policy.