In the natural course of shoulder instability, about half of the patients never experience a subsequent incident after the primary one, but also chronically unstable shoulders may eventually stabilize. The risk for recurrent episodes after primary dislocation is high among young and athletic men, and therefore, prompt surgery is often proposed for this group. Also, in treatment of chronic post-traumatic instability, surgery is often suggested. A significant increase in the total incidence and proportion of arthroscopic surgery has been widely reported during the last two decades. Network meta-analyses (NMAs) have not been previously published on traumatic shoulder instability. Shoulder capsular surgery incidence rates have not been studied in Finland. Glenohumeral osteoarthritis (OA) has previously been studied in the long run with non-anatomic or mixed surgical interventions with no special attention directed to arthroscopic anatomic fixation methods. This thesis aimed to evaluate the best available evidence in treatment of traumatic shoulder instability, trends in shoulder capsular surgery procedure incidences in Finland during 1999-2008 between open and arthroscopic procedures geographically, between different age groups, and between publicly and privately funded hospitals after a change in the reimbursement system of occupational and traffic insurance in 2005. We retrospectively analysed a group of patients after arthroscopic anatomic fixation methods in terms of radiological glenohumeral OA and condition-specific shoulder function. According to a moderate level of evidence, surgical treatment of primary traumatic shoulder dislocation seems to lead to fewer redislocations than non-surgical management, and according to a low level of evidence open anatomic fixation prevents redislocations more efficiently than arthroscopic anatomic fixation in treatment of chronic post-traumatic shoulder instability. The total incidence of shoulder capsular surgery procedures and the proportion of arthroscopic procedures increased significantly in Finland between 1999 and 2008 with notable geographical variation. Since 2005, the procedure incidences have slightly decreased in publicly funded hospitals, but have continued to increase in privately funded hospitals without a distinct change in trend. We commonly observed mild glenohumeral OA among patients treated with arthroscopic anatomic fixation method, but its impact on shoulder function was minor. Operative treatment reduced efficiently recurrent shoulder dislocations after primary traumatic shoulder dislocation, but routine surgical intervention can still be considered over-treatment in the typical patient population. In Finland, total incidence of shoulder capsular surgery procedures, proportion of arthroscopic procedures and geographical variation in procedures increased significantly, which might indicate differences in regional treatment practices or background incidence. The insurance companies may have referred patients to private hospitals for better availability of treating surgeons, faster access to treatment, and lower total expenses. In the long run, mild radiological glenohumeral OA was commonly observed, but the surgical method itself is probably not significant in the development of glenohumeral OA. The impact of glenohumeral OA on the patient’s shoulder function was minor, with few objective findings.
|Status||Publicerad - 2019|
|MoE-publikationstyp||G5 Doktorsavhandling (artikel)|
Bibliografisk informationM1 - 151 s. + liitteet
- 3126 Kirurgi, anestesiologi, intensivvård, radiologi