Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study

doi:10.1016/j.jse.2019.02.020

Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study

College of Medicine

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Hypothesis and background: Male sex has been identified as a risk factor for both primary shoulder dislocation and recurrent instability, and male patients more often undergo surgery for instability. Despite published discrepancies between sexes regarding the incidence and surgical rates of shoulder instability, there is little detail on the differences in presentation, mechanism of injury, and intraoperative findings. The purpose of this study was to explore these differences. Methods: Prospective baseline data from 1010 patients in the Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort were analyzed for sex-related differences using demographic characteristics, patient-reported outcomes, radiographic findings, intraoperative findings, and surgical procedures performed. Two-tailed t tests and χ² tests were used to compare the continuous and categorical data, respectively. Patients were categorized using the Frequency, Etiology, Direction, Severity (FEDS)classification system. Results: Male patients comprised 81.3% of the cohort. Male patients had a significantly higher rate of traumatic instability and rate of initial instability while playing sports, as well as significantly higher activity scores. Female patients had significantly lower preoperative American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, 36-Item Health Survey, and Single Assessment Numeric Evaluation scores. No difference in the number of dislocations was found between male and female patients. Intraoperatively, male patients had higher rates of labral pathology and bone loss whereas female patients had higher rates of capsular laxity. These differences resulted in more Latarjet procedures for male patients and more soft-tissue procedures for female patients. Conclusion: There are differences between male and female patients in the etiology of their instability, baseline patient-reported outcomes, and associated shoulder pathology, likely reflecting intrinsic and activity-related variation. These differences may influence clinical decision making and patient outcomes.

Original language	English
Pages (from-to)	1013-1021
Number of pages	9
Journal	Journal of Shoulder and Elbow Surgery
Volume	28
Issue number	6
DOIs	https://doi.org/10.1016/j.jse.2019.02.020
State	Published - Jun 2019

Bibliographical note

Funding Information:
This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky.

Funding Information:
The existence of epidemiologic and prognostic differences in male and female orthopedic patients has also been well described, with variation attributed to a combination of anatomy, hormones, and genetics.28 For example, epidemiologic differences are seen in adhesive capsulitis and hip fractures, which are both more common in female patients, but male patients have a significantly higher mortality rate after hip fracture than female patients. 1,4,9 Sex-related differences have been described in anterior cruciate ligament (ACL) injuries. Varying rates of additional intra-articular pathology associated with ACL injuries have been demonstrated via sex-based analysis, with evidence supporting the contribution of intrinsic joint differences between male and female patients. 3,18 Furthermore, higher rates of ACL tears have consistently been reported in female patients, ranging from 2 to 6 times higher than those in their male counterparts depending on the sport, with injuries also associated with specific menstrual-cycle hormone levels. 22,27 Studying differences between sexes often elicits results demonstrating that patients with a similar diagnosis do not represent a homogeneous group. This, in turn, provides context and association between etiology, pathology, and ultimately, intervention, allowing surgeons to provide evidence-driven treatments and prognoses to patients.This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky.

Publisher Copyright:
© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees

Keywords

FEDS classification
Level II
MOON shoulder
Prospective Cohort Design
Shoulder instability
Treatment Study
patient-reported outcomes
sex-based analysis
shoulder instability surgery

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

Access to Document

10.1016/j.jse.2019.02.020

Cite this

@article{597563d312244d82ae782e6b2af241ff,

title = "Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study",

abstract = "Hypothesis and background: Male sex has been identified as a risk factor for both primary shoulder dislocation and recurrent instability, and male patients more often undergo surgery for instability. Despite published discrepancies between sexes regarding the incidence and surgical rates of shoulder instability, there is little detail on the differences in presentation, mechanism of injury, and intraoperative findings. The purpose of this study was to explore these differences. Methods: Prospective baseline data from 1010 patients in the Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort were analyzed for sex-related differences using demographic characteristics, patient-reported outcomes, radiographic findings, intraoperative findings, and surgical procedures performed. Two-tailed t tests and χ2 tests were used to compare the continuous and categorical data, respectively. Patients were categorized using the Frequency, Etiology, Direction, Severity (FEDS)classification system. Results: Male patients comprised 81.3% of the cohort. Male patients had a significantly higher rate of traumatic instability and rate of initial instability while playing sports, as well as significantly higher activity scores. Female patients had significantly lower preoperative American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, 36-Item Health Survey, and Single Assessment Numeric Evaluation scores. No difference in the number of dislocations was found between male and female patients. Intraoperatively, male patients had higher rates of labral pathology and bone loss whereas female patients had higher rates of capsular laxity. These differences resulted in more Latarjet procedures for male patients and more soft-tissue procedures for female patients. Conclusion: There are differences between male and female patients in the etiology of their instability, baseline patient-reported outcomes, and associated shoulder pathology, likely reflecting intrinsic and activity-related variation. These differences may influence clinical decision making and patient outcomes.",

keywords = "FEDS classification, Level II, MOON shoulder, Prospective Cohort Design, Shoulder instability, Treatment Study, patient-reported outcomes, sex-based analysis, shoulder instability surgery",

author = "Magnuson, {Justin A.} and Wolf, {Brian R.} and Cronin, {Kevin J.} and Jacobs, {Cale A.} and Ortiz, {Shannon F.} and Bishop, {Julie Y.} and Baumgarten, {Keith M.} and Bollier, {Matthew J.} and Bravman, {Jonathan T.} and Brophy, {Robert H.} and Cox, {Charles L.} and Feeley, {Brian T.} and Grant, {John A.} and Jones, {Grant L.} and Kuhn, {John E.} and Ma, {C. Benjamin} and Marx, {Robert G.} and McCarty, {Eric C.} and Miller, {Bruce S.} and Seidl, {Adam J.} and Smith, {Matthew V.} and Wright, {Rick W.} and Zhang, {Alan L.} and Hettrich, {Carolyn M.}",

note = "Funding Information: This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky. Funding Information: The existence of epidemiologic and prognostic differences in male and female orthopedic patients has also been well described, with variation attributed to a combination of anatomy, hormones, and genetics.28 For example, epidemiologic differences are seen in adhesive capsulitis and hip fractures, which are both more common in female patients, but male patients have a significantly higher mortality rate after hip fracture than female patients. 1,4,9 Sex-related differences have been described in anterior cruciate ligament (ACL) injuries. Varying rates of additional intra-articular pathology associated with ACL injuries have been demonstrated via sex-based analysis, with evidence supporting the contribution of intrinsic joint differences between male and female patients. 3,18 Furthermore, higher rates of ACL tears have consistently been reported in female patients, ranging from 2 to 6 times higher than those in their male counterparts depending on the sport, with injuries also associated with specific menstrual-cycle hormone levels. 22,27 Studying differences between sexes often elicits results demonstrating that patients with a similar diagnosis do not represent a homogeneous group. This, in turn, provides context and association between etiology, pathology, and ultimately, intervention, allowing surgeons to provide evidence-driven treatments and prognoses to patients.This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky. Publisher Copyright: {\textcopyright} 2019 Journal of Shoulder and Elbow Surgery Board of Trustees",

year = "2019",

month = jun,

doi = "10.1016/j.jse.2019.02.020",

language = "English",

volume = "28",

pages = "1013--1021",

number = "6",

}

Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study. / Department of Orthopaedic Surgery Sports Medicine University of Kentucky.
In: Journal of Shoulder and Elbow Surgery, Vol. 28, No. 6, 06.2019, p. 1013-1021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Sex-related differences in patients undergoing surgery for shoulder instability

T2 - a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study

AU - Magnuson, Justin A.

AU - Wolf, Brian R.

AU - Cronin, Kevin J.

AU - Jacobs, Cale A.

AU - Ortiz, Shannon F.

AU - Bishop, Julie Y.

AU - Baumgarten, Keith M.

AU - Bollier, Matthew J.

AU - Bravman, Jonathan T.

AU - Brophy, Robert H.

AU - Cox, Charles L.

AU - Feeley, Brian T.

AU - Grant, John A.

AU - Jones, Grant L.

AU - Kuhn, John E.

AU - Ma, C. Benjamin

AU - Marx, Robert G.

AU - McCarty, Eric C.

AU - Miller, Bruce S.

AU - Seidl, Adam J.

AU - Smith, Matthew V.

AU - Wright, Rick W.

AU - Zhang, Alan L.

AU - Hettrich, Carolyn M.

N1 - Funding Information: This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky. Funding Information: The existence of epidemiologic and prognostic differences in male and female orthopedic patients has also been well described, with variation attributed to a combination of anatomy, hormones, and genetics.28 For example, epidemiologic differences are seen in adhesive capsulitis and hip fractures, which are both more common in female patients, but male patients have a significantly higher mortality rate after hip fracture than female patients. 1,4,9 Sex-related differences have been described in anterior cruciate ligament (ACL) injuries. Varying rates of additional intra-articular pathology associated with ACL injuries have been demonstrated via sex-based analysis, with evidence supporting the contribution of intrinsic joint differences between male and female patients. 3,18 Furthermore, higher rates of ACL tears have consistently been reported in female patients, ranging from 2 to 6 times higher than those in their male counterparts depending on the sport, with injuries also associated with specific menstrual-cycle hormone levels. 22,27 Studying differences between sexes often elicits results demonstrating that patients with a similar diagnosis do not represent a homogeneous group. This, in turn, provides context and association between etiology, pathology, and ultimately, intervention, allowing surgeons to provide evidence-driven treatments and prognoses to patients.This study was supported, in part, by research grants from the Orthopaedic Research & Education Fund and by the National Center for Advancing Translational Sciences through grant UL1TR001998, as well as the Dean of the College of Medicine, University of Kentucky. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Kentucky. Publisher Copyright: © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees

PY - 2019/6

Y1 - 2019/6

N2 - Hypothesis and background: Male sex has been identified as a risk factor for both primary shoulder dislocation and recurrent instability, and male patients more often undergo surgery for instability. Despite published discrepancies between sexes regarding the incidence and surgical rates of shoulder instability, there is little detail on the differences in presentation, mechanism of injury, and intraoperative findings. The purpose of this study was to explore these differences. Methods: Prospective baseline data from 1010 patients in the Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort were analyzed for sex-related differences using demographic characteristics, patient-reported outcomes, radiographic findings, intraoperative findings, and surgical procedures performed. Two-tailed t tests and χ2 tests were used to compare the continuous and categorical data, respectively. Patients were categorized using the Frequency, Etiology, Direction, Severity (FEDS)classification system. Results: Male patients comprised 81.3% of the cohort. Male patients had a significantly higher rate of traumatic instability and rate of initial instability while playing sports, as well as significantly higher activity scores. Female patients had significantly lower preoperative American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, 36-Item Health Survey, and Single Assessment Numeric Evaluation scores. No difference in the number of dislocations was found between male and female patients. Intraoperatively, male patients had higher rates of labral pathology and bone loss whereas female patients had higher rates of capsular laxity. These differences resulted in more Latarjet procedures for male patients and more soft-tissue procedures for female patients. Conclusion: There are differences between male and female patients in the etiology of their instability, baseline patient-reported outcomes, and associated shoulder pathology, likely reflecting intrinsic and activity-related variation. These differences may influence clinical decision making and patient outcomes.

AB - Hypothesis and background: Male sex has been identified as a risk factor for both primary shoulder dislocation and recurrent instability, and male patients more often undergo surgery for instability. Despite published discrepancies between sexes regarding the incidence and surgical rates of shoulder instability, there is little detail on the differences in presentation, mechanism of injury, and intraoperative findings. The purpose of this study was to explore these differences. Methods: Prospective baseline data from 1010 patients in the Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort were analyzed for sex-related differences using demographic characteristics, patient-reported outcomes, radiographic findings, intraoperative findings, and surgical procedures performed. Two-tailed t tests and χ2 tests were used to compare the continuous and categorical data, respectively. Patients were categorized using the Frequency, Etiology, Direction, Severity (FEDS)classification system. Results: Male patients comprised 81.3% of the cohort. Male patients had a significantly higher rate of traumatic instability and rate of initial instability while playing sports, as well as significantly higher activity scores. Female patients had significantly lower preoperative American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, 36-Item Health Survey, and Single Assessment Numeric Evaluation scores. No difference in the number of dislocations was found between male and female patients. Intraoperatively, male patients had higher rates of labral pathology and bone loss whereas female patients had higher rates of capsular laxity. These differences resulted in more Latarjet procedures for male patients and more soft-tissue procedures for female patients. Conclusion: There are differences between male and female patients in the etiology of their instability, baseline patient-reported outcomes, and associated shoulder pathology, likely reflecting intrinsic and activity-related variation. These differences may influence clinical decision making and patient outcomes.

KW - FEDS classification

KW - Level II

KW - MOON shoulder

KW - Prospective Cohort Design

KW - Shoulder instability

KW - Treatment Study

KW - patient-reported outcomes

KW - sex-based analysis

KW - shoulder instability surgery

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Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON)Shoulder Instability cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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