Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons
Background: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. Met...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Biology |
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| Online Access: | https://www.mdpi.com/2079-7737/12/2/291 |
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| author | Michael T. Freehill Iain R. Murray Emilio Calvo Alexandre Lädermann Uma Srikumaran |
| author_facet | Michael T. Freehill Iain R. Murray Emilio Calvo Alexandre Lädermann Uma Srikumaran |
| author_sort | Michael T. Freehill |
| collection | DOAJ |
| description | Background: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. Methods: An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher’s exact tests and post-hoc tests using Bonferroni-adjusted <i>p</i>-values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman’s correlation tests. Results: In total, 499 surgeons with a median of 15 years of experience (IQR = 9–25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, <i>p</i> < 0.0001), Latarjet (53% vs. 12%, <i>p</i> < 0.001), ARCR < 3 cm (80% vs. 42%, <i>p</i> < 0.001) and >3 cm (84% vs. 61%, <i>p</i> < 0.001), aTSA (50% vs. 21%, <i>p</i> < 0.001) and rTSA with subscapularis repair (61% vs. 22%, <i>p</i> < 0.001) and without subscapularis repair (57% vs. 17%, <i>p</i> < 0.001), and isolated BT (18% vs. 7%, <i>p</i> = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, <i>p</i> < 0.001), Latarjet (78% vs. 44%, <i>p</i> < 0.001), ARCR < 3 cm (50% vs. 17%, <i>p</i> < 0.001) and >3 cm (34% vs. 13%, <i>p</i> < 0.001), and aTSA (69% vs. 41%, <i>p</i> < 0.001) and rTSA with subscapularis repair (70% vs. 35%, <i>p</i> < 0.001) and without subscapularis repair (73% vs. 39%, <i>p</i> < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = −0.20, <i>p</i> < 0.001), Latarjet (r = −0.25, <i>p</i> < 0.001), ARCR < 3 cm (r = −0.14, <i>p</i> = 0.014) and >3 cm (r = −0.20, <i>p</i> < 0.002), and aTSA (r = −0.37, <i>p</i> < 0.001), and rTSA with subscapularis repair (r = −0.10, <i>p</i> = 0.049) and without subscapularis repair (r = −0.19, <i>p</i> = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, <i>p</i> < 0.001), Latarjet (4.6 vs. 3.6 weeks, <i>p</i> < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks <i>p</i> < 0.001) and >3 cm (5.9 vs. 5.1 weeks, <i>p</i> < 0.001), aTSA (4.9 vs. 4.3 weeks, <i>p</i> < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, <i>p</i> = 0.031), and isolated BT (3.7 vs. 3.3 weeks, <i>p</i> = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated. Conclusions: There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. Level of Evidence: Level IV. |
| first_indexed | 2024-03-11T09:08:31Z |
| format | Article |
| id | doaj.art-fac693e22de04b0cae15b54fffbcd165 |
| institution | Directory Open Access Journal |
| issn | 2079-7737 |
| language | English |
| last_indexed | 2024-03-11T09:08:31Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biology |
| spelling | doaj.art-fac693e22de04b0cae15b54fffbcd1652023-11-16T19:14:21ZengMDPI AGBiology2079-77372023-02-0112229110.3390/biology12020291Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder SurgeonsMichael T. Freehill0Iain R. Murray1Emilio Calvo2Alexandre Lädermann3Uma Srikumaran4Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA 94305, USAEdinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh EH4 2XU, UKShoulder and Elbow Reconstructive Surgery Unit, Orthopaedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Universidad Autonoma, 28040 Madrid, SpainLa Tour Hospital, University of Geneva, Geneva University Hospitals, 1211 Geneva, SwitzerlandDepartment of Orthopaedic Surgery, John Hopkins University School of Medicine, Baltimore, MD 21205, USABackground: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. Methods: An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher’s exact tests and post-hoc tests using Bonferroni-adjusted <i>p</i>-values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman’s correlation tests. Results: In total, 499 surgeons with a median of 15 years of experience (IQR = 9–25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, <i>p</i> < 0.0001), Latarjet (53% vs. 12%, <i>p</i> < 0.001), ARCR < 3 cm (80% vs. 42%, <i>p</i> < 0.001) and >3 cm (84% vs. 61%, <i>p</i> < 0.001), aTSA (50% vs. 21%, <i>p</i> < 0.001) and rTSA with subscapularis repair (61% vs. 22%, <i>p</i> < 0.001) and without subscapularis repair (57% vs. 17%, <i>p</i> < 0.001), and isolated BT (18% vs. 7%, <i>p</i> = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, <i>p</i> < 0.001), Latarjet (78% vs. 44%, <i>p</i> < 0.001), ARCR < 3 cm (50% vs. 17%, <i>p</i> < 0.001) and >3 cm (34% vs. 13%, <i>p</i> < 0.001), and aTSA (69% vs. 41%, <i>p</i> < 0.001) and rTSA with subscapularis repair (70% vs. 35%, <i>p</i> < 0.001) and without subscapularis repair (73% vs. 39%, <i>p</i> < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = −0.20, <i>p</i> < 0.001), Latarjet (r = −0.25, <i>p</i> < 0.001), ARCR < 3 cm (r = −0.14, <i>p</i> = 0.014) and >3 cm (r = −0.20, <i>p</i> < 0.002), and aTSA (r = −0.37, <i>p</i> < 0.001), and rTSA with subscapularis repair (r = −0.10, <i>p</i> = 0.049) and without subscapularis repair (r = −0.19, <i>p</i> = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, <i>p</i> < 0.001), Latarjet (4.6 vs. 3.6 weeks, <i>p</i> < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks <i>p</i> < 0.001) and >3 cm (5.9 vs. 5.1 weeks, <i>p</i> < 0.001), aTSA (4.9 vs. 4.3 weeks, <i>p</i> < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, <i>p</i> = 0.031), and isolated BT (3.7 vs. 3.3 weeks, <i>p</i> = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated. Conclusions: There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. Level of Evidence: Level IV.https://www.mdpi.com/2079-7737/12/2/291slingrehabilitationLatarjetBankartarthroplastyprosthesis: reverse |
| spellingShingle | Michael T. Freehill Iain R. Murray Emilio Calvo Alexandre Lädermann Uma Srikumaran Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons Biology sling rehabilitation Latarjet Bankart arthroplasty prosthesis: reverse |
| title | Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons |
| title_full | Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons |
| title_fullStr | Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons |
| title_full_unstemmed | Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons |
| title_short | Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons |
| title_sort | shoulder surgery postoperative immobilization an international survey of shoulder surgeons |
| topic | sling rehabilitation Latarjet Bankart arthroplasty prosthesis: reverse |
| url | https://www.mdpi.com/2079-7737/12/2/291 |
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