Trends in surgical procedures for shoulder instability among patients with Ehlers-Danlos syndrome or joint hypermobility syndrome

Arman Kishan, MBBS; Kiyanna Thomas, BS; Sanjay Kubsad, BS; Stanley Zhu, BS; Mohini Gharpure, BS; Henry Maxwell Fox, MD; Sarah Y. Nelson, MD; Umasuthan Srikumaran, MD

JSES International (Nov 2024)

Trends in surgical procedures for shoulder instability among patients with Ehlers-Danlos syndrome or joint hypermobility syndrome

Arman Kishan, MBBS,
Kiyanna Thomas, BS,
Sanjay Kubsad, BS,
Stanley Zhu, BS,
Mohini Gharpure, BS,
Henry Maxwell Fox, MD,
Sarah Y. Nelson, MD,
Umasuthan Srikumaran, MD

Affiliations

Arman Kishan, MBBS: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Kiyanna Thomas, BS: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Sanjay Kubsad, BS: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Stanley Zhu, BS: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Mohini Gharpure, BS: Medical College of Georgia, Augusta, GA, USA
Henry Maxwell Fox, MD: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Sarah Y. Nelson, MD: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Umasuthan Srikumaran, MD: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Corresponding author: Umasuthan Srikumaran, MD, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.

Journal volume & issue: Vol. 8, no. 6
pp. 1164 – 1168

Abstract

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Background: Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are connective tissue disorders characterized by increased joint laxity, affecting musculoskeletal health and quality of life. In this study, we explored recent trends in surgical treatment of shoulder instability among patients with these disorders. Methods: We searched the PearlDiver Mariner database, which includes deidentified US all-payer claims data from 2010 to 2020. We used procedure and diagnostic codes for EDS and JHS to select patients. The primary outcome was the yearly trend in relative utilization of the following 4 shoulder instability procedures: arthroscopic stabilization, Latarjet coracoid transfer, open capsulolabral repair, and open capsulolabral shift. Results: Among 109,274 patients with EDS and 453,885 with JHS, 3.4% and 0.8% underwent shoulder instability procedures, respectively. Arthroscopic stabilization was the predominant treatment, with a mean utilization rate of 78% for EDS and 83% for JHS. Notably, the age at surgery increased for EDS patients but decreased for JHS patients. Female patients represented large proportions of those undergoing procedures in both the EDS group (83%) and the JHS group (77%). Conclusions: Our findings indicate a consistent preference for arthroscopic stabilization in treating shoulder instability in patients with EDS and JHS. The trends in age suggest shifts in treatment strategies, possibly influenced by advancements in nonoperative interventions or varying symptom severity. The higher proportion of female patients aligns with the known prevalence of connective tissue disorders in women. Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies for these challenging connective tissue disorders.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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