gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022)

25. - 28.10.2022, Berlin

Are we doing too many Arthroscopic Subacromial Decompressions? An analysis of recent changes in practice

Meeting Abstract

  • presenting/speaker Chetan Dojode - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom
  • Karthik Chandrasekaran - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom
  • Surendra Patnaik - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom
  • Medhat Hasan - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom
  • Preetha Sadasivan - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom
  • Thiagarajah Selvan - East Surrey Hospital, Trauma & Orthopaedics, Redhill, United Kingdom

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB73-213

doi: 10.3205/22dkou583, urn:nbn:de:0183-22dkou5833

Veröffentlicht: 25. Oktober 2022

© 2022 Dojode et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Aim is to analyze recent changes in management of subacromial shoulder pain in United Kingdom.

Objective is to identify the true incidence of primary ASDs performed in contrast to those performed as an adjuvant.

The effectiveness of the Arthroscopic subacromial Decompression (ASD) operation compared to a placebo procedure or no treatment has shown no difference in recent literature [1]. Getting It Right First Time (GIRFT) report in United Kingdom recommends the reduction of unnecessary surgery for patients with subacromial shoulder pain [2].

Methods: Combined retrospective and prospective study done in a district general hospital in United Kingdom. Retrospective analysis of patients who underwent shoulder arthroscopy over a 12 months period (January 2017 to December 2017) and prospective analysis over 6 months (November 2020 to April 2021) was done. Information was collected from clinical letters, preoperative MRI/USG investigations and clinical coding department. Number of isolated ASD were separated from ASDs done as an adjuvant with rotator cuff repair, acromio-clavicular joint excision or other procedures.

Results and conclusion: During the retrospective study, a total 207 ASDs were done. 57 (27.5%) patients underwent isolated ASD whereas in 150 (72.5%) patients it was done as an adjuvant procedure. Out of patients who had isolated ASD, 17 (8.2%) patients had preoperative suspected diagnosis of rotator cuff tear or calcific tendonitis, however intra-operatively primary pathology was not found and ASD was performed for symptom relief. Only 39 (18.8%) had a preoperative diagnosis of pure impingement syndrome.

In the prospective study, there were 38 patients who underwent ASD. Isolated ASD was done in 7 (18.4%) patients. The 5 (13.1%) patients had preoperative suspected diagnosis of rotator cuff tear and later found during surgery that they don't need rotator repair and ASD was offered. Only 2 (5.2%) patients had preoperative diagnosis of pure impingement, one of these patients had malunited greater tuberosity fracture.

Compared to study done in 2017, there has been a significant decrease in ASD surgeries been offered for primary subacromial impingement in 2021. This trend is in accordance with GIRFT report recommendations.

The number of primary Arthroscopic subacromial decompressions offered for pure subacromial impingement has decreased significantly in recent years. A small number of isolated Arthroscopic subacromial decompressions were performed with suspected preoperative diagnosis of rotator cuff tear or as a diagnostic procedure. Most of the Arthroscopic subacromial decompressions are being done as an adjuvant procedure.


References

1.
Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, Shirkey BA, Donovan JL, Gwilym S, Savulescu J, Moser J, Gray A, Jepson M, Tracey I, Judge A, Wartolowska K, Carr AJ; CSAW Study Group. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): A multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018 Jan 27;391(10118):329-38. DOI: 10.1016/S0140-6736(17)32457-1 Externer Link
2.
Getting It Right First Time (GIRFT). Getting It Right in Orthopaedics – Reflecting on Success and Reinforcing Improvement. GIRFT; 2020. Available from: https://www.gettingitrightfirsttime.co.uk/girft-reports/ Externer Link