Reverse total shoulders - which patients are satisfied?

Predictors of patient satisfaction after reverse shoulder arthroplasty

These authors sought to determine patient satisfaction and to identify predictors of satisfaction at two years after reverse shoulder arthroplasty (RSA) in 161 patients.

Improvements in ASES, Shoulder Activity Scale, VAS pain, and SF-12 physical component summary scores were associated with higher satisfaction.

On multivariate analysis, patients with higher preoperative ASES scores were less satisfied after surgery. In addition, patients with worse VAS fatigue and SF-12 mental and physical component summary scores preoperatively had lower satisfaction. 

Comment: This paper is instructive. First of all, it shows that patient factors (such as those measured by the SF-12 mental health and VAS fatigue scores) play heavily into the patients' satisfaction with this procedure (and probably with most other procedures as well).  Along with the problem, the procedure and the provider, the patient is one of the 4 Ps that determine the result of treatment.  

Secondly, while the means and medians are interesting, the variation is even more interesting as shown in the chart below. Patients with a preoperative ASES score of 100 have little room for improvement and are unlikely to be satisfied with surgery (see this link). Some patients experienced a drop of 64 points in their ASES score; these folks are likely to be unsatisfied.

Thus we come to the "tipping point"for  reverse total shoulders (see this link), i.e. when is it time to do this surgery. As shown in the link above, a recent study found that the tipping point for reverses was an ASES score of 38, a value approximately the same as the average preoperative ASES score of 35 in this paper.

The take away point is that surgeons should be cautious about offering elective surgery to patients with high levels of preoperative self-assessed comfort and function as well as those who have poor mental and physical health.

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To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.

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