Most patients, who have new instability after a surgery to fix shoulder instability, DON’T want more surgery.
A 2014 paper presentation at the Arthroscopy Association of North America found that patients who had surgery to stabilize a dislocating shoulder had about a 1 in 4 chance of having another episode of dislocation or subluxation (partial disloction) at some point after the operation.
In spite of this fact the vast majority of those people elected not to have more surgery.
This is an interesting study. It has certain strengths in that it was done by the same surgeon, which helps control for technique variability.
The follow-up was good: the surgeon was able to contact 84% of his patients which is a pretty high number.
And it points to two pertinent findings: 1) sometimes patients develop unstable shoulders even after an operation and 2) that the higher your activity level, the more likely you are to have instability at some point after surgery.
Techniques have evolved in the 7 years since this presentations came out. As surgeons we are now more attuned to some of the things that lead to long-term success of these operations.
But what I find most interesting about this study is that it is really about patient preference. Patient preference is what patients are willing to do or decide when confronted with a particular outcome. Often this is different than we surgeons would think.
Why they chose not to have surgery is unclear from the synopsis of this presentation. Perhaps in the patients’ minds, their shoulder was “good enough”. Or it was at least not bad enough to consider going through another surgery with all of the needed rehabilitation.
I bet if we had a surgery that could fix this problem where rehabilitation was only two weeks many of these people would consider another operation. However my hunch is that patients factor in how much of a time and effort commitment it is to do the rehab process and this weighs on their decision-making.
We need more studies like this. Just because people choose not to get another operation does not necessarily mean that all of the outcomes of operations are perfect or that there is not room for improvement. There definitely is.