Deciding on the right surgical method is a big step for patients facing shoulder conditions. When non-surgical or conservative management can no longer provide relief, the conversation generally turns to surgery, and which method may be advised: arthroscopic (minimally invasive) or traditional open surgery.
The choice between these techniques can influence your recovery timeline and the nature of your rehabilitation. Learning the differences helps you discuss options with your specialist and GP, and helps you make more informed decisions about your treatment plan.
Dr James McLean specialises in upper limb orthopaedics, using both arthroscopic and open surgery techniques. In consultation with Dr McLean, at his clinics in Eastwood, Elizabeth Vale and Bedford Park, he will talk you through his specialist review and the options available to you.
What is Arthroscopic Surgery and when is it used?
Arthroscopic shoulder surgery is a type of minimally invasive surgery, more commonly known as keyhole surgery. This method uses a small camera (called an arthroscope) that is inserted through tiny incisions. The camera displays live, high-definition images on a monitor that your surgeon uses to guide miniature surgical instruments with precision.
Reasons for Arthroscopic Surgery
An arthroscopic technique is used to address shoulder issues with less disruption to the healthy tissue around the joint.
- Detailed Views: The arthroscope provides such a magnified, high-definition view that it can help your surgeon see details or damage that may have gone unseen in an open procedure or an MRI scan. This more advanced view means specialists can provide a more accurate diagnosis and more tailored treatment of your shoulder condition.
- Tissue Preservation: Using small portals instead of one large incision helps the surgeon work on internal structures while keeping the overlying muscle more intact. Guided by HD imaging, the surgeon uses miniature surgical instruments and is more precise, helping preserve and avoid the healthy tissue surrounding the site.
Currently, Dr James McLean uses this minimally invasive shoulder surgery with advanced lighting, sophisticated instruments and high-definition imaging to support his surgical precision.
Open Surgery and When It Is Used
Open shoulder surgery involves a large incision to provide direct sight and access, and remains necessary for specific conditions and circumstances. Surgeon’s may use this traditional method for certain complex procedures requiring extensive tissue manipulation, bone work or implant placement.
Reasons for an Open Method
Dr McLean will select this technique for tactile feedback, depth orientation or when managing multiple structures simultaneously. Circumstances where the procedure requires extensive exposure and direct tissue manipulation that is not possible arthroscopically.
- Complex Fractures: Severe injuries where bone fragments need to be manually realigned and held in place.
- Large Rotator Cuff Tears: Cases involving significant tendon retraction where a tendon transfer is needed.
- Bone Loss Reconstruction: Situations where bone grafting is required to provide stability to the shoulder socket.
- Complex Revision Surgery: When a previous operation needs to be corrected or old implants need replacing.
Comparing Recovery and Clinical Results
Research shows that both methods support pain management and increase range of movement and daily function. Patients often ask which method is better, but the answer is specific to the injury and the individual.
Pain and Initial Recovery
Research shows that arthroscopic techniques can lead to less initial discomfort in recovery because the incisions are so small. In long-term functional scores, that look at how well you can move your arm after six to twelve months, results are similar between the two methods.
Clinical Results
Clinical data shows, for conditions like rotator cuff surgery, that patients reported less pain and more mobility after an arthroscopic shoulder procedure, compared to those that underwent the open surgery. But large-scale analysis reveals no significant differences in clinical outcomes between open and arthroscopic shoulder procedures for other conditions such as anterior shoulder dislocation treatment.
Potential Benefits of Arthroscopic Surgery
Many people show preference for arthroscopic shoulder surgery because of the lower impact on the body's external tissues.
Reduced Surgical Trauma
Smaller incisions mean less scarring and a lower risk of infection or wound-related complications compared to larger open incisions from open surgery.
Minimally invasive techniques also preserve more surrounding soft tissues, maintaining blood supply and reducing post-operative inflammation.
Lower Complication Rates
The overall reported rate of medical complications after arthroscopic surgery was 2.2%, according to the Journal of the American Academy of Orthopaedic Surgeons. In their report, complications ranged from 0.3% for veno-thromboembolism to 0.04% for cerebrovascular accidents. This research demonstrated the value of an arthroscopic technique to reduce surgical trauma and complication rates when compared to open surgery.
Quicker Recovery and Rehabilitation
Surrounding muscles are not detached during arthroscopic surgery, and patients can usually begin certain passive movements earlier in their recovery compared to open surgery recovery.
Patients often experience less post-operative discomfort and require fewer pain medications compared to open surgery patients, as well as a reduced rehabilitation time period with an earlier return to normal activities through a personalised plan.
Cosmetic Results
Arthroscopic surgery uses small incisions, between 5mm and 10mm in length that often require only one or two sutures or even simple adhesive strips to close. By preserving more skin and underlying tissue, the body can heal with less internal and external scarring. The marks usually appear red initially, and then flatten and fade over several months.
Patient Preference and Choice
Research shows perception significantly favours minimally invasive approaches when patients are given an informed choice. The study of two centres found that at center A, 88% would prefer arthroscopy if they were to have shoulder surgery, as would 96% of patients at center B. Among patients at center A, 14% would avoid shoulder surgery if the only option was open surgery, and 25% would at center B.
In South Australia, patient preference is leaning toward minimally invasive options. Many people want arthroscopy to try support a sooner return to daily life and work.
Making the Decision that’s Right for You
The decision between arthroscopic and open surgery depends on so many contributors, including the severity of your condition or injury, your lifestyle, your anatomy and your goals. It also depends on if your surgeon performs and has experience in both.
Dr James McLean, Orthopaedic Surgeon, specialises in upper limb conditions and is extensively experienced in both arthroscopic shoulder surgery and open shoulder surgery. During a consultation at our Eastwood, Elizabeth Vale, or Bedford Park rooms, he will provide specialist review of your imaging and discuss your lifestyle needs to recommend a surgical plan that is tailored to you, if appropriate. Whether your condition requires a keyhole repair or a traditional open reconstruction, the goal is to support your return to function and help manage pain.
Dr James McLean specialises in upper limb conditions and has extensive experience in both arthroscopic and open shoulder surgery. During a consultation at our Eastwood, Elizabeth Vale or Bedford Park rooms, he provides a specialist review of your imaging and will discuss your lifestyle needs to recommend a surgical plan that is tailored to you, if one is appropriate. Regardless of whether your condition requires arthroscopic repair or open reconstruction, the goal remains the same - to support you in managing any pain and returning to activities.
Next Steps?
- Consult With Your GP: Discuss your symptoms and request a referral to an upper limb specialist like Dr James McLean.
- Specialist Assessment: A physical examination, specialist review of your scans and discussion will determine if surgery is a suitable option for you.
- Personalised Surgical Planning: If surgery is required, the method and planning will be tailored to your anatomy, your activity level and the specific damage within the joint.
- Preparation: Our team guides you through the entire process, including how to prepare for the day of your procedure.
- Recovery: A recovery and rehabilitation plan is custom developed to support your physical therapy and return to daily activities.
Your Referral for Shoulder Pain or Injury
Are you in Adelaide, dealing with a shoulder injury or experiencing shoulder pain? Ask your GP for a referral to Dr James McLean, Orthopaedic Surgeon, specialising in upper limb conditions and injuries. His experience in both arthroscopic and open shoulder surgery helps provide you recommendations and treatment plans that are based on your individual needs.
Contact our practice to discuss your shoulder condition and book in your specialist assessment.
References:
Shin, Jason & Popchak, Adam & Musahl, Volker & Irrgang, Jay & Lin, Albert. (2018). Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database. JAAOS: Global Research and Reviews. 2. e093. 10.5435/JAAOSGlobal-D-18-00093.
Sperling, J. W., Smith, A. M., Cofield, R. H., & Barnes, S. (2007). Patient perceptions of open and arthroscopic shoulder surgery. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 23(4), 361–366. https://doi.org/10.1016/j.arthro.2006.12.006
*This article is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. All surgery carries risks, and results may vary. Dr James McLean (MED0001064034) PhD MS MBBS FRACS FAOrthA, is an Orthopaedic Specialist. Consult with Dr McLean for a personalised treatment plan.