Thursday, April 14, 2011

Total shoulder for arthritis: the results

In considering the value of a procedure, it is important to measure its effect on the overall health of the patient. Our shoulder fellow Boorman did such a study for total shoulder replacement and found that the effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting.

As the reader will recall from previous posts regarding the Simple Shoulder Test (SST), we consider the patient's own assessment of shoulder comfort and function to be the 'gold standard' for evaluating the result of the treatment of a shoulder condition. Over fifteen years ago, we published a study on the Early Effectiveness of Shoulder Arthroplasty for Patients Who Have Primary Glenohumeral Degenerative Joint Disease, using the SST. Subsequently, our shoulder fellows Fehringer , Boorman, and Churchill used this tool in Characterizing the Functional Improvement After Total Shoulder Arthroplasty for Osteoarthritis. They found that total shoulder arthroplasty substantially improved the Simple Shoulder Test self-assessments of comfort and function in individuals with shoulder arthritis. On average, shoulders achieved approximately two-thirds of the maximum possible improvement, regardless of the preoperative level of function. A similar study, The magnitude and durability of functional improvement after total shoulder arthroplasty for degenerative joint disease, was published by our shoulder fellow Goldberg. The key data from this study are shown in the figure below.

Our fellows Antoniou and Rozencwaig studied the Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease. They found that male gender, preoperative physical function, social function, mental health and shoulder function before surgery were the strongest predictors of the quality of the result from total shoulder replacement. These same authors had previously investigated the correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.

Our shoulder fellows Saltzman and Mercer published an important study entitled, Comparison of patients undergoing primary shoulder arthroplasty before and after the age of fifty. They found that younger patients having shoulder joint replacement were more likely to have complex forms of shoulder arthritis,  such as capsulorrhaphy arthropathy, rheumatoid arthritis, and posttraumatic athritis. Only 21% of the younger patients had primary degenerative joint disease, whereas 66% of the older patients had that diagnosis. These more complex forms of arthritis may complicate the surgery, the rehabilitation and the outcome of shoulder joint replacement.


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