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Factors Related to Patient Dissatisfaction Versus Objective Failure After Arthroscopic Shoulder Stabilization for Instability

Title
Factors Related to Patient Dissatisfaction Versus Objective Failure After Arthroscopic Shoulder Stabilization for Instability
Authors
Park, InKang, Jun-SeokJo, Yoon-GeolShin, Sang-Jin
Ewha Authors
신상진박인
SCOPUS Author ID
신상진scopus
Issue Date
2019
Journal Title
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME
ISSN
0021-9355JCR Link

1535-1386JCR Link
Citation
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME vol. 101, no. 12, pp. 1070 - 1076
Publisher
LIPPINCOTT WILLIAMS &

WILKINS
Indexed
SCI; SCIE; SCOPUS WOS
Document Type
Article
Abstract
Background: After arthroscopic stabilization procedures for recurrent anterior shoulder instability, patients are not always satisfied with their shoulder, even when the operation successfully restored stability. The aim of this study was to evaluate the factors associated with subjective patient dissatisfaction after arthroscopic stabilization procedures for recurrent anterior shoulder instability and to compare these factors with those associated with objective surgical failure. Methods: A total of 195 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability were included in this study. At the 2-year postoperative visit, subjective patient dissatisfaction was assessed with a 15-point scale. Objective surgical failure was defined as postoperative dislocation or subluxation events requiring revision surgery. Several factors, including age at the first dislocation, age at the time of the operation, presence of an off-track Hill-Sachs lesion, width of the Hill-Sachs lesion, size of the glenoid bone defect, and number of instability events, were recorded. Multivariable linear regression analysis and multivariable logistic regression analysis were performed using a backward stepwise procedure as the variable selection method. Results: Fifteen patients (7.7%) had recurrent instability requiring revision surgery. In the group of 180 patients without surgical failure, the width of the Hill-Sachs lesion (regression coefficient: 0.052, p = 0.011) and number of instability events (regression coefficient: 0.103, p = 0.029) were positively correlated with subjective patient dissatisfaction, whereas concomitant repair of a SLAP (superior labrum anterior-posterior) lesion showed negative correlation (regression coefficient: 20.926, p = 0.004). In the total cohort of patients, objective surgical failure was correlated with the age at the time of the operation (odds ratio [OR]: 0.851, p = 0.042), size of the glenoid bone defect (OR: 1.172, p < 0.001), and number of instability events (OR: 1.147, p = 0.048). Other variables, including an off-track Hill-Sachs lesion or a concomitant remplissage procedure, were not correlated with subjective patient dissatisfaction or objective surgical failure. Conclusions: Factors related to subjective patient dissatisfaction differed from those related to objective surgical failure. For a better understanding of the clinical outcomes after surgery, surgeons should assess the factors that correlate with subjective patient dissatisfaction and objective surgical failure. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DOI
10.2106/JBJS.18.01243
Appears in Collections:
의과대학 > 의학과 > Journal papers
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