Comparing midterm clinical outcome of surgical versus ultrasound guided needle aspiration of the calcific deposits for therapy resistant calcifying tendinitis of the shoulder. A comparative cohort study.

PURPOSE: Comparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome.

METHODS: A comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual.

RESULTS: At midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group.

DISCUSSION: At midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment.