Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability

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

doi:10.1016/j.jse.2019.12.002

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Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability

Journal article

Peer reviewed

Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability

Justin A. Magnuson, Brian R. Wolf, Kevin J. Cronin, Cale A. Jacobs, Shannon F. Ortiz, John E. Kuhn, Keith M. Baumgarten, Julie Y. Bishop, Matthew J. Bollier, Jonathan T. Bravman, …

Journal of shoulder and elbow surgery, Vol.29(4), pp.784-793

04/2020

DOI: 10.1016/j.jse.2019.12.002

PMCID: PMC7197435

PMID: 32197767

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https://www.ncbi.nlm.nih.gov/pmc/articles/7197435View

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Abstract

The Frequency, Etiology, Direction, and Severity (FEDS) system was developed as a simple but reliable method for classifying shoulder instability based on 4 factors attainable by history and physical examination: frequency (solitary, occasional, or frequent); etiology (traumatic or atraumatic); direction (anterior, posterior, or inferior); and severity (subluxation or dislocation). This study investigated the epidemiology and 2-year surgical outcomes for the FEDS categories in the prospective Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. At the time of surgery, 1204 patients were assigned to the FEDS categories. Follow-up data were available for 636 of 734 patients (86.6%) who had undergone surgery at least 2 years prior to analysis. The most common categories were further analyzed by patient-reported outcomes (PROs) (American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability index, Single Assessment Numeric Evaluation scores) and rates of recurrent subluxation, recurrent dislocation, and revision surgery. Of the 36 FEDS categories, 16 represented at least 1% of patients. Occasional traumatic anterior dislocation (OTAD) was the most common category, with 16.4% of patients. Five other anterior categories (solitary traumatic anterior subluxation, occasional traumatic anterior subluxation [OTAS], frequent traumatic anterior subluxation [FTAS], solitary traumatic anterior dislocation, and frequent traumatic anterior dislocation) and one posterior category (solitary traumatic posterior subluxation [STPS]) represented at least 5% of patients. PROs improved significantly for each category. The highest rates of recurrent subluxation occurred in FTAS, OTAS, and OTAD cases; dislocation, OTAS and FTAS cases; and further surgery, OTAD cases. The lowest rates of failure occurred in STPS cases. Downward trends in PROs and higher failure rates were noted with an increasing number of preoperative dislocations. Different FEDS categories showed varying degrees of improvement and failure rates, indicating that the system can be used to provide prognostic insight for presurgical education. Overall, outcomes decreased with a higher number of preoperative dislocations.

dislocation

FEDS classification

instability

PROs

Shoulder

subluxation

Details

Title: Subtitle: Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability
Creators: Justin A. Magnuson - University of Kentucky
Brian R. Wolf - University of Iowa Hospitals and Clinics
Kevin J. Cronin - University of Kentucky
Cale A. Jacobs - University of Kentucky
Shannon F. Ortiz - University of Iowa
John E. Kuhn - Vanderbilt University Medical Center
Keith M. Baumgarten - Orthopedic Institute
Julie Y. Bishop - The Ohio State University
Matthew J. Bollier - University of Iowa
Jonathan T. Bravman - Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
Robert H. Brophy - Department of Orthopedics, Washington University Saint Louis, St Louis, MO, USA
Charles L. Cox - Vanderbilt University Medical Center
Brian T. Feeley - University of California, San Francisco
John A. Grant - University of Michigan
Grant L. Jones - The Ohio State University
C. Benjamin Ma - University of California, San Francisco
Robert G. Marx - Hospital for Special Surgery
Eric C. McCarty - Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
Bruce S. Miller - University of Michigan
Matthew V. Smith - Department of Orthopedics, Washington University Saint Louis, St Louis, MO, USA
Rick W. Wright - Vanderbilt University Medical Center
Alan L. Zhang - University of California, San Francisco
Carolyn M. Hettrich - Brigham and Women's Hospital
MOON Shoulder Group
Resource Type: Journal article
Publication Details: Journal of shoulder and elbow surgery, Vol.29(4), pp.784-793
DOI: 10.1016/j.jse.2019.12.002
PMID: 32197767
PMCID: PMC7197435
NLM abbreviation: J Shoulder Elbow Surg
ISSN: 1058-2746
eISSN: 1532-6500
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100001279, name: Orthopaedic Research and Education Foundation; DOI: 10.13039/100001279, name: Orthopaedic Research & Education, award: 14-003; DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: UL1TR001998; DOI: 10.13039/100007472, name: University of Kentucky
Language: English
Date published: 04/2020
Academic Unit: Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
Record Identifier: 9984294949702771

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