Sunday, March 6, 2016

Total shoulder arthroplasty - which patients are satisfied?

Comparison of satisfied and dissatisfied patients 2 to 5 years after anatomic total shoulder arthroplasty.

These authors reported on 234 primary TSAs performed by a single surgeon for glenohumeral osteoarthritis with a minimum 2-year follow-up.  207 (88.5%) were satisfied with their procedure.

Dissatisfied patients had significantly lower ASES scores both before and after surgery as well as a significantly lower preoperative to postoperative change in ASES score. Patients with ASES score changes <12 points were 19 times more likely to be dissatisfied.

Dissatisfied patients demonstrated significantly lower changes in active forward flexion, abduction, and external rotation. 

Preoperative opioid use was more common in the dissatisfied group (46%) than the satisfied group (24%), but other co-morbidities did not show a significant difference.  Patient satisfaction was related more to postoperative pain and self-perceived ability to perform activities of daily living than to range of motion.

Comment: This study points out that patients are more likely to be satisfied with the results of a total shoulder if the shoulder is more comfortable and more functional after surgery than it was before. 

It would be most instructive if the authors presented the preoperative clinical and radiographic characteristics that were associated with a satisfactory result in the eyes of the patient.


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