These authors point out that previous studies have demonstrated young age, high preoperative function, and neurologic dysfunction to be predictors of poor functional improvement after a reverse total shoulder arthroplasty (RSA), but that there is little known about the RSA outcomes for patients electing to have RSA for function more than pain.
They conducted a retrospective matched-cohort study on 260 RSA patients treated by an individual surgeon with a minimum 2-years follow-up. 195 patients had at least moderate baseline pain (“Function+Pain”), pre-defined by existing literature as a Visual Analog Scale (VAS) pain score > 3, were matched 3:1 with 65 patients based on gender, indication, and age to those with a minimal pain with VAS score ≤ 3 (“Function”).
Patients in both groups showed no differences in most recent postoperative function, overall improvement in functional scores, and active motion.
However, pain scores improved only for patients with at least moderate baseline pain.
The Function cohort also had worse percent of maximal SST and ASES improvement, and a lower proportion of these patients exceeded the threshold in percent of maximal improvement that predicts an “excellent” outcome.
Patient satisfaction was significantly different, as 10.8% of patients who elected to have RSA for loss of function alone were unsatisfied.
The authors concluded that RSA patients with minimal preoperative pain achieve significant improvements in function and motion similar to those who choose to have RSA for both pain and function, but are less satisfied and are less likely to achieve an “excellent” outcome.
Comment: This interesting study points out that patients who have a reverse total shoulder because of shoulder pain AND loss of shoulder function realize greater improvement and are more satisfied than patients who have a reverse total should because of the loss of shoulder function alone.
Recently there has been interest in the Simple Shoulder Test (SST) "tipping point" at which point patients decide to proceed with a reverse total shoulder (see this link).
The list of SST questions is shown below.
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