Open shoulder stabilization: current trends and 1-year postoperative complications

BACKGROUND: Shoulder instability is commonly treated by arthroscopic stabilization. However, open stabilization procedures remain important in management of complex instability. Despite continued use of these procedures, the relative frequency of related complications remains poorly described. This study investigates current trends in open shoulder stabilization and characterizes major postoperative complications. METHODS: PearlDiver, a national insurance database of orthopedic patients, was used to identify open shoulder stabilization procedures from 2007 to 2010. Current Procedural Terminology codes for 4 procedures—Bankart repair, coracoid transfer, and anterior and posterior glenoid bone grafting—were used to track procedural trends. The 1-year postoperative complications were identified and categorized into 5 groups: dislocation treated with closed reduction, closed manipulation under anesthesia, reoperation with arthroscopy, reoperation with open surgery, and others. χ(2) analysis determined statistical significance. RESULTS: There were 2678 open shoulder stabilization procedures performed, with a 1-year complication rate of 12.3%. Relative proportion of open Bankart repairs decreased (82.5% to 69.8%), whereas proportion of coracoid transfers increased (7.7% to 19%). Posterior glenoid bone grafting had the highest complication rate (20.7%). Rate of total complications was 9.8% in patients 10-24 years, 13.6% in patients 25-54 years, and 25.9% in patients >55 years. CONCLUSIONS: Based on our patient database sample, a significant decline in the relative use of open Bankart repair was observed. Our analysis indicates that the use of bone transfer procedures was correlated with significantly higher reoperation rates than open Bankart repair, particularly in the older patient cohort. Further studies comparing open stabilization procedures with contemporary arthroscopic techniques are indicated.