'Shrug off' shoulder surgery myth, study suggests

In fact, the Johns Hopkins researchers say, their study shows that patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays and less costs than patients undergoing hip or knee replacement.

Arthritis is estimated to affect more than 16 million Americans and is a common cause of shoulder pain and mobility loss. However, many reject shoulder joint replacement, fearful of risks and costs. The Hopkins research team, led by Edward McFarland, M.D., director of the Division of Adult Orthopedics at The Johns Hopkins Hospital, analyzed anonymous patient information provided by the Maryland Health Services Cost Review Commission, the state's hospital rate-regulator. They looked at all arthroplasties performed in Maryland to alleviate osteoarthritis pain between 1994 and 2001, including details of 15, 414 hip surgeries, 34, 471 knee operations and 625 shoulder procedures.

"After looking at how all these patients fared, we concluded that, comparatively, total shoulder surgery is just as safe and effective as other types of arthroplasties," says McFarland. "Lower numbers of shoulder procedures done both regionally and nationally may indicate that many people live with shoulder pain because they fear that the corrective surgery is too risky or costs more than similar procedures. But we have found that this is just not true."

The findings appeared in a recent online version of the journal Clinical Orthopedics.

According to nationwide 2003 Medicare figures, 6,700 people had shoulder joints replaced that year, compared to 106,887 hip replacements and 199,195 total knee replacements.

Shoulder arthroplasty consists of placement of a metal and plastic artificial joint similar to the ball-and-socket construction used to substitute for hip and knee joints. The socket, or scapula, is scraped clean and fitted with a plastic mount, while the ball at the top of the humerus bone in the arm is replaced with a metal implant.

Patients in the study who had shoulder surgery had far less in-hospital post-surgical complications (7.5 percent) compared with those patients who had their hips and knees replaced (15.5 percent and 14.7 percent, respectively). McFarland's team also determined that the average time a person remained hospitalized after the surgery was lowest for those recovering from shoulder procedures (just 2.42 days for shoulder patients, versus more than four days for both the hip and knee equivalents).

Shoulder arthroplasty is also less expensive, according to McFarland. A shoulder replacement's total costs, on average, are $10, 351; whereas hip replacement surgery averages $15, 442, and knee arthroplasty, $14, 674.

In the study period, there were no fatalities associated with shoulder replacement, compared to 27 deaths among hip replacement patients and 54 among knee replacement patients. Given the small number of shoulder surgeries actually performed, McFarland noted that the mortality rates for the procedure were not statistically different from the other forms of arthroplasty. But finding no resulting deaths attributed to total shoulder replacement in the group of patients studied did add "clinical significance" to the idea that shoulder surgery is relatively safer. The study's authors suspect that the higher number of deaths related to hip and knee procedures may be related to repeat surgeries stemming from postoperative complications during the same hospitalization, a need for blood transfusions or extended intensive care stays.

McFarland says most patients who are candidates for total shoulder replacement surgery are "at the end of their rope" trying to manage chronic pain and disability with drugs. "Ninety-nine percent of the people who have a shoulder replacement for arthritis get pain relief and say that they wish they had done it sooner," says McFarland. "This study indicates there may be little reason to wait."

Source: Johns Hopkins Medical Institutions

Problem: implant infection, solution: nanotech surfaces
Orthopaedic implants help millions of Americans stay active. But these medical devices are prone to infection, forcing patients back to surgery for repair or replacement. Now, for the first time, a team of engineers has shown that zinc or titanium oxide nanosurfaces can reduce the presence of bacteria, a technique that can be applied to implants to reduce the number of these costly and debilitating infections.
Study reveals compression stockings incorrectly used in 29 percent of patients
An original study, published in the September issue of the American Journal of Nursing (AJN), revealed that graduated compression stockings were used incorrectly in 29% of the patients and sized incorrectly in 26% of the patients. These stockings play an important role in preventing the formation of deep vein clots that can result in pulmonary complications and death. AJN is the largest circulating nursing journal in the world, and is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Effects of healing touch therapy being studied
Often, a gentle hand on your shoulder when you're upset is all it takes to ease your mind and calm your nerves. Now, University of Cincinnati (UC) researchers are looking at a similar occurrence by pairing a complementary therapy known as Healing Touch with mild sedation to see if the technique truly calms patients undergoing minor procedures.
Acupuncture reduces pain and dysfunction in head and neck cancer patients after neck dissection
New data from a randomized, controlled trial found that acupuncture provided significant reductions in pain, dysfunction, and dry mouth in head and neck cancer patients after neck dissection. The study was led by David Pfister, MD, Chief of the Head and Neck Medical Oncology Service, and Barrie Cassileth, PhD, Chief of the Integrative Medicine Service, at Memorial Sloan-Kettering Cancer Center (MSKCC). Dr. Pfister presented the findings today at the annual meeting of the American Society for Clinical Oncology.
Patients' expectation of getting better is crucial in recovery from whiplash
Research into whiplash published in this week’s PLoS Medicine has found that an individual’s expectation of getting better plays a crucial role in the likelihood of his or her recovery, even after the severity of their physical and psychological symptoms are taken into account. Lena Holm at Karolinska Institutet in Stockholm, Sweden and colleagues from Sweden and Canada investigated the role of individuals’ expectation of recovery by using a questionnaire-based study of adult insurance claimants.
Some women more likely to miss or ignore heart attack warning signs
Many women under age 55 aren’t seeking timely treatment for heart attack because they expect the warning signs and their reaction to follow a Hollywood script — tightening in the chest, shortness of breath, clutching the chest while dropping to one knee.
Shoulder transplant performed in Italy
Doctors in Italy said they performed the first transplant of a human shoulder.
Severe hypertension: 'Silent killer' still on the loose
High blood pressure may be one of the top killers in the country, but you’d never know it by the way we’re behaving, say scientists attending the annual congress of the Society for Critical Care Medicine (SCCM).

'Shrug off' shoulder surgery myth, study suggests

Related stories:

News discussion: