Sunday, November 18, 2012

Patient reported activities after reverse shoulder arthroplasty JSES

Patient reported activities after reverse shoulder arthroplasty: JSES

This article presents patient responses to an activity questionnaire sent to 128 patients, average age 73 years,  having had a primary reverse total shoulder from 2004 to 2008 (average followup 3.6 years). The implants included a variety of designs, including Delta Extend, Aequalis, Biomet, and Encore. There was a 39% non-response rate. The authors concluded that the responding patients had activities similar to those they reported previously for total shoulder and hemiarthroplasty (a paper with only slightly lower non-response rates: 31% and 37%).

Table II of this paper reports the results for only 52 respondents (which would be a 59% non-response rate). Of these 52, over 10% reported activities such as snow/dirt shoveling, use of the wheelbarrow, sawing/chopping wood, road biking, free weight lifting, hunting/shooting, and riding an ATV. 

What we cannot know from this study includes (1) what were the activity levels of the non-responders, (2) how did the activity levels at followup compare with the activity levels before surgery, (3) what were the revision rates among the 128 patients, and (4) was there a correlation between the revision rate and the activities of the patients. The observation that 27 patients report shoveling snow using their reverse total shoulder does not indicate that this is advisable.

In contrast to some, we are conservative in the use of reverse total shoulder arthroplasty in patients who desire high levels of physical activity or who are prone to falling or who require their arms for ambulation. In those individuals we consider an uncemented CTA arthroplasty if the shoulder is stable and if 90 degrees of active elevation is present before surgery. 

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