Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clin Orthop Rel Res 2007;455:183-9.


Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests. In fact, the study shows that people who undergo shoulder replacement 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.

Osteoarthritis 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 research team, led by Edward McFarland, MD, director of the Division of Adult Orthopedics at The Johns Hopkins Hospital, analyzed patient information from 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."

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.

Patients in the study who had shoulder surgery had far fewer in-hospital postsurgical 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 4 days for both the hip and knee equivalents). Shoulder arthroplasty is also less expensive. A shoulder replacement costs, on average, $10,351; whereas hip replacement surgery averages $15,442, and knee arthroplasty, $14,674.

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."

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