These authors reviewed the outcomes of 1089 patients having anatomic total shoulders (TSA) patients and 1332 patients having reverse total shoulders (rTSA) (mean follow-up period, 49 months) from an international registry with a single arthroplasty system. A multiple linear regression model with backward stepwise selection identified the preoperative parameters that were significant predictors of postoperative clinical outcome metric scores and motion measures for both rTSA and aTSA.
They found that patients with greater postoperative range of motion (ROM) had greater preoperative ROM. For TSA, patients with higher postoperative American Shoulder and Elbow Surgeons (ASES) scores had higher preoperative ASES scores. Higher postoperative ASES scores were also associated with no history of shoulder surgery, and the presence of greater preoperative active external rotation.
For rTSA, patients with higher postoperative ASES scores had higher preoperative ASES scores. Higher postoperative ASES scores were also associated with no history of shoulder surgery, no history of tobacco use, less preoperative passive external rotation, and greater preoperative active external rotation.
Comment: This study suggests that better postoperative scores can be achieved in patients with better preoperative scores. This brings up the question of whether the result of an arthroplasty is best judged by the postoperative score or by the improvement from the preoperative score to the postoperative score.
Surgeons focused on the postoperative score might tend to operate on shoulders that are less severely compromised before surgery whereas those focused on the postoperative to preoperative improvement might tend to operate on shoulders that are more compromised before surgery.
When we read articles or listen to presentations we should pay attention to how the word "outcome" is used; should "outcome" be used to refer to the postoperative condition of the shoulder or to the improvement resulting from the procedure?
This issue transcends all aspects of our field. If a patient having a superior capsular reconstruction has 140 degrees of active elevation after surgery is that a good result or does the result depend on whether the preoperative active elevation is 130 degrees or 50?
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A video of our approach to total shoulder arthroplasty can be seen by clicking this link.
A video of our approach to reverse shoulder arthroplasty can be seen by clicking this link.
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