The concept of the "tipping point", i.e. the degree of disability a patient has when they decide to proceed with surgery, was introduced in the article published two years ago: "The “tipping point” for 931 elective shoulder arthroplasties", see this link. In that article the mean Simple Shoulder Test (SST) tipping point for reverse total shoulder arthroplasty (RSA) was 1.5 ± 1.8.
The authors of the current article reviewed a total of 3975 primary RSAs performed over a 10-year period were retrospectively reviewed from a multi-institutional database. They found that the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Simple Shoulder Test and the Constant score remained similar over the 10-year study period, with all demonstrating slightly higher tipping points later in the study. ROM measures all showed small increases over time, demonstrating better ROM before electing to undergo RSA in later years.
Comment: It is of interest that the SST tipping point values in this paper are substantially higher than those of the original article referenced above). This indicates that there is substantial variation among practices in the degree of disability experienced by the patient before a reverse total shoulder is applied. The tipping point provides a useful metric for characterizing and understanding these inter practice differences.
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