gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Surgery not superior to non-operative therapy in the treatment of anterolateral shoulder pain. A randomised controlled study with 12-year follow-up

Meeting Abstract

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  • presenting/speaker Saara Ketola - Coxa Hospital for Joint Replacement, Tampere, Finland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN35-1356

doi: 10.3205/17dkou086, urn:nbn:de:0183-17dkou0867

Published: October 23, 2017

© 2017 Ketola.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: The aim was to assess the long-term additional benefits of subacromial decompression in the treatment of anterolateral shoulder pain.

Methods: 140 patients with anterolateral shoulder pain were randomised into two treatment groups: 1) combined treatment group and 2) supervised exercise treatment group. In Group 1 arthroscopic acromioplasty was performed and followed by a supervised and structured exercise treatment. In Group 2 the patients were treated only with supervised exercises. The exercise program was similar in both groups, the only differing thing being the operation. Self reported pain on visual analogue scale (VAS) was the primary outcome measure. Secondary measures were disability, working ability, pain at night, Shoulder Disability Questionnaire and painful days during the preceding three months. The blinded clinical follow-ups were at 2 and 5 years. The late follow up (mean 12.3 years) was carried out with questionnaires. The information collected included working status and conditions including changes at work due to shoulder disabilities, retirement, sick leaves, medication and painful days. Statistics: Descriptive statistics: percentages, frequencies, and means. Group comparisons: the independent samples t-test. Comparisons within groups over time: paired samples t-test. Equal proportions of pain-free patients between groups: the chi-squared test. P<0.05 considered significant.

Results and Conclusion: At randomisation the two groups did not differ. Self-reported pain was 6.4 in Group 1 and 6.5 in Group 2 (p=0.73). At late follow-up point self-reported pain as intention to treat was 2.8 and 1.8, respectively (p= 0.12)(n=90). At 2 (n=134) and 5 years (n=109) both groups reached significantly better values compared to baseline but there were no differences between groups; neither in the secondary outcome measures nor 15D quality of life index. The change from baseline to 12 years was highly significant p<0.001 in both groups. Between 5 to 12 years the changes in self-reported pain in VAS within treatment groups were +0.8 in Group 1 and -0.3 in Group 2 (p=0.14). When analysed per protocol, the operated had +0.9 and the non-operated -0.4 change in self-reported pain in VAS. This difference is close to 1.5 being the clinical important change yet not statistically significant (p=0.06). In all the operated patients the pain started to get worse but continued to decline within the non-operated.

This study verifies the findings of previous prospective studies. The natural history of anterolateral shoulder pain probably plays a significant role. Even though the operated patients had stronger belief in the recovery and thus a greater placebo effect of surgery, the exercise group reached similar or even better results. In clinical practice this means reducing the costs (treatment and sick leaves) and minimizing the complications. The indications for arthroscopic acromioplasty should be redefined. Structured exercise treatment should be the basis of treatment.