Beach-chair and lateral decubitus patient positioning are commonly used for shoulder arthroscopy, each with its own advantages and disadvantages. However, there has been no clear consensus on the superior position for arthroscopic posterior shoulder labral repair. A recent study conducted by Ryan W. Paul, Usman Zareef, Sydney Streicher, Alim Osman, Brandon J. Erickson, Kevin B. Freedman, Sommer Hammoud, and Meghan E. Bishop aimed to compare the clinical and patient-reported outcomes of these two positioning methods. The study hypothesized that patient positioning would not significantly impact the outcomes of the surgery.
Advantages and Disadvantages of Beach-Chair and Lateral Decubitus Positioning
Before delving into the findings of the study, it’s important to understand the benefits and disadvantages of each patient positioning method.
Beach-Chair Positioning
The beach-chair position involves the patient sitting upright, resembling a relaxed position on a beach chair. This positioning offers several advantages:
- Accessibility: The surgeon has better access to the shoulder joint, allowing for improved visualization and maneuverability during the procedure.
- Gravity: Gravity helps to retract soft tissues, aiding in exposure and reducing the risk of damage.
- Communication: Communication between the surgeon and patient is easier in this position, enhancing patient comfort and cooperation.
However, beach-chair positioning also has its drawbacks:
- Hemodynamic Instability: The upright position may lead to fluctuations in blood pressure and potential complications in patients with cardiovascular issues.
- Neurological Complications: Rare but serious complications, such as stroke or cerebral hypoperfusion, have been associated with this position.
Lateral Decubitus Positioning
The lateral decubitus position involves the patient lying on their side. This positioning method also offers unique advantages:
- Stability: The lateral decubitus position provides stability for patients during the surgery, reducing the risk of falls or unintentional movements.
- Reduced Hemodynamic Effects: This position minimizes the hemodynamic changes associated with beach-chair positioning, making it a preferred option for patients with cardiovascular concerns.
- Neurological Safety: Lateral decubitus positioning reduces the risk of neurological complications compared to beach-chair positioning.
Similar to beach-chair positioning, lateral decubitus positioning has a few disadvantages:
- Access Challenges: The surgeon may face access issues due to the limited exposure and difficulty in manipulating instruments.
- Patient Discomfort: Patients may experience shoulder and back discomfort due to the extended duration of the procedure and positioning.
Clinical and Patient-Reported Outcomes of the Study
The study conducted by Paul et al. included 126 patients who underwent arthroscopic posterior labral repair, with 69 patients in the lateral decubitus position and 57 in the beach-chair position. The average follow-up period was 2.6 ± 1.7 years.
The researchers compared various factors, such as the number of anchors used, perioperative and postoperative complications, redislocations, subjective instability, reoperation, revision, and patient-reported outcomes.
The key findings of the study revealed:
- No significant differences in pre- or perioperative factors between patients in the beach-chair and lateral decubitus positions.
- Similar rates of postoperative dislocations, subjective instability, reoperations, revisions, complications, and return to sports in both groups.
- No significant difference in postoperative pain, function, and subjective instability scores between the two positioning methods.
These findings indicate that patient positioning does not significantly affect the clinical and patient-reported outcomes of arthroscopic posterior shoulder labral repair. Both beach-chair and lateral decubitus positions yielded successful outcomes, with an overall recurrence rate of 8.7%.
Impact on Postoperative Pain and Function
In terms of postoperative pain and function, the study results demonstrated no significant difference between patients in the beach-chair and lateral decubitus positions. This suggests that both positioning methods result in similar pain levels and functional improvements following surgery.
Patients who underwent arthroscopic posterior shoulder labral repair experienced relief from their preoperative symptoms, regardless of their positioning during the surgery.
Risk Factors for Recurrent Instability
The multivariate regression analysis conducted in the study identified that increased age was a weak independent risk factor for subjective recurrent posterior shoulder instability. Although age was a contributing factor, it should be noted that this association was relatively weak.
Other factors, such as patient-specific characteristics and surgical technique, may play a more significant role in predicting the risk of recurrent instability post-surgery.
Overall Recurrence Rates for Posterior Shoulder Labral Repair
The study reported an overall recurrence rate of 8.7% for posterior shoulder labral repair. This rate is consistent with previous research and suggests that arthroscopic techniques for such repair yield favorable outcomes for the majority of patients.
It is crucial to consider individual patient factors, such as age, activity level, and severity of injury, when assessing the likelihood of recurrence after surgery.
Takeaways
In summary, the study comparing beach-chair and lateral decubitus patient positioning for arthroscopic posterior shoulder labral repair revealed that both methods had similar clinical and patient-reported outcomes. Patient positioning did not significantly affect postoperative pain, function, or subjective instability scores. The overall recurrence rate of 8.7% aligns with existing literature, indicating favorable outcomes for most patients undergoing this procedure.
However, it is important to consult with a healthcare professional and consider individual factors when deciding on the appropriate patient positioning and surgical approach for posterior shoulder labral repair.
Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.
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