Exploring Surgical Outcomes in Joint Instability

Insights from a New Study on Ehlers-Danlos Syndrome

The Ehlers-Danlos Syndromes (EDS) cause widespread connective tissue issues, with one of the most difficult symptoms being joint instability. This can lead to frequent subluxations, dislocations, chronic pain, and damage to soft tissues. For many patients, managing these problems with conservative methods, like physical therapy or braces, is often the first step. However, when these fail, surgery becomes a potential option.

Joint surgery is often beneficial for some EDS patients, particularly after less invasive or conservative approaches haven’t provided relief. However, determining the best surgical strategy is challenging due to a lack of consensus and the unique complications seen in EDS patients. A recent study looked at how surgical management can help, focusing on the role of arthroscopy, functional outcomes, and the need for additional surgeries (operations).

Study Design

The study looked at the surgical outcomes of 69 patients with non-vascular EDS (including 55 with hypermobile EDS, or hEDS) who underwent surgery for joint instability. The surgeries took place at a specialized reference center in France and involved various joints, including the:

• Knee (39%)

• Ankle (22%)

• Shoulder (17%)

• Wrist (14%)

• Elbow (7%)

This reference center in France had experience with 1368 EDS patients, and 236 of these individuals required surgery for joint issues. Keep in mind that the specific rates of surgical interventions and techniques at this center may differ from what is typically seen in the U.S.

Arthroscopy

Arthroscopy, a minimally invasive surgical technique, was used in 20.8% of the surgeries, primarily for knee problems. The advantages of arthroscopy include smaller incisions, faster recovery times, and less tissue damage compared to traditional “open” surgery.

Reoperation Rates by Joint

One of the most interesting findings in this study was the high rate of reoperation in EDS patients, depending on the joint involved:

• Knee: 60%

• Wrist: 50%

• Shoulder: 40.9%

• Elbow: 44.4%

• Ankle: 35.7%

These numbers underscore the complexity of treating joint instability in EDS patients. While reoperations were common, more research is needed to determine how these rates compare to patients without EDS, and what underlying factors may be contributing to the need for additional surgeries.

Anesthesia Concerns

Anesthesia is a commonly discussed issue in the EDS community, and I’m glad the authors took a look at this in the study. In this study, 42% of the patients had complications with general anesthesia, and 47% experienced resistance to local or regional anesthesia.

Patient Satisfaction

Despite the complexities and rates of reoperation, 70% of patients expressed satisfaction with their surgical outcomes, especially in cases involving non-dominant joints. Interestingly, dominant-side shoulder surgeries had the highest dissatisfaction rate, with 58.3% of patients unhappy with the results.

Does a Diagnosis Matter?

One important finding from the study was the role of an EDS diagnosis prior to surgery. Surgeons were aware of or suspected EDS in only about one-third of the cases before surgery. However, the study revealed that surgeries tend to have better outcomes when performed in patients with a known diagnosis of EDS before the procedure. This emphasizes the importance of diagnosing EDS early, particularly in patients with joint instability, to guide surgical planning and improve the chances of success.

Final Thoughts

This study provides insights into the benefits and challenges of joint surgery for patients with EDS. While surgery can improve the quality of life and reduce pain for some patients, the high rates of reoperation and anesthesia complications highlight the need for careful surgical planning and individualized treatment approaches. Additionally, given the significance of having a diagnosis prior to surgery, it’s important that orthopedic surgeons evaluate for hypermobility and EDS and that patients see surgeons experienced with operating on EDS patients. Further research is needed to refine surgical techniques and develop more effective treatment strategies tailored to the unique needs of this patient population.

Reference:

Abihssira S, Benistan K, Nourissat G. Functional benefit of joint surgery in patients with non-vascular Ehlers-Danlos syndrome: results of a retrospective study. Orphanet J Rare Dis. 2024;19(1):351. Published 2024 Sep 23. doi:10.1186/s13023-024-03261-3