Which patients have poorer early results from total shoulder arthroplasty and how do these patients fare at two years after surgery?

The clinical outcome of some patients at 3 to 6 months after shoulder arthroplasty may be poorer than expected.  It is not clear whether these patients can "catch up" to expectations by two years after surgery. The authors of Patients with poor early clinical outcomes after anatomic total shoulder arthroplasty have sustained poor performance at 2 years from surgery reviewed 784 anatomic total shoulders for osteoarthritis from a multicenter database  performed using a single implant design.

18% (144) of these cases had an American Shoulder and Elbow Association (ASES) scores below the 20th percentile at 3 to 6 month after surgery, which they referred to as "early poor performance." As shown in the table below, in comparison to "early good performers,"  these patients were more likely to be of younger age, female, smokers, and to have had prior surgery. 

At 2-year follow-up, 51% (n = 74) of patients with early poor performance at either 3- or 6-month follow-up had persistent poor performance, as defined by and ASES score less than 82 points (the patient acceptable symptomatic state (PASS)).

Independent predictors of persistent poor performance were hypertension and diabetes.

Comment: This study found that the 20% of patients with the lowest ASES scores at 3 to 6 months after surgery were relatively unlikely to achieve the ASES patient acceptable symptomatic state (PASS) at two years after surgery. The identified risk factors for lower early ASES scores (younger age, female, smokers, prior surgery) and the risk factors for early poor performers achieving the PASS at two years (hypertension and diabetes) are difficult to modify. Yet the identification of patients with these characteristics may be useful by indicating those who might benefit from an in-depth discussion prior to surgery as well as extraordinary support after surgery (e.g. frequent postoperative contact with the surgical team, directed physical therapy, and a structured pain management program) during the first several months after surgery in an effort to improve their two year outcomes.

An alternative approach for presenting these data might be to show a scatter plot of the 3 to 6 month ASES score against the 2 year score. This method may provide greater insight into the relationship between the scores at these two time points instead of using two (different) thresholds for each (3 to 6 month ASES score <20% and 2 year ASES score>82). 

Here'a a hypothetical example:

This is especially relevant because there will always be patients with 3 to 6 month ASES scores in the bottom 20%, even if advances in techniques and technology improve the  outcomes. Perhaps in the future, the bottom 20% at 3 to 6 months may not be "poor performers".

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link)