Surgeons and patients are interested in the factors predictive of outcome after total shoulder arthroplasty. The authors of Disease diagnosis and arthroplasty type are strongly associated with short-term postoperative patient reported outcomes in patients undergoing primary total shoulder arthroplasty conducted a large observational study of 1,042 patients having primary TSA at a major academic center with one-year follow-up documented by patient reported outcome measures (PROMS). 30% had reverse total shoulders (rTSAs) for cuff tear arthropathy (CTA), 26% had rTSAs for osteoarthritis (OA), and 44% had anatomic total shoulders (aTSAs) for OA. The decision to perform aTSA or rTSA for OA was apparently left to discretion of the individual surgeon. No patient in this study had an aTSA for CTA.
Lower one-year PROMS scores were most prominently associated with a diagnosis of CTA, lower preoperative mental health and workers compensation insurance. Other negative factors included younger age, female sex, current smoking, chronic pain diagnosis, history of prior surgery, lower baseline PROMS, absence of glenoid bone loss. Of note, none of these factors are modifiable by the surgeon. Surgeon controlled variables, such as the implant selected and operative technique were not presented.
The authors found that patients that had to be excluded from analysis because they failed to provide 1 year PROMs were more likely to have a diagnosis of CTA, to be younger, to have race other than white, to have more comorbidities, to have less education, to inhabit areas of higher area deprivation index, to have lower baseline PROMS, to have more preoperative opioid use, and to have more chronic pain or psychiatric diagnoses. First year complications and revisions were not presented.
Comment: This is a carefully done observational study on a large number of total shoulder arthroplasties performed at a leading academic medical center. The authors provide the classic figure one, showing numbers of patients excluded and the reasons.
Graphical displays of the data from their Table 3 are shown below for both the American Shoulder and Elbow Surgeons score and the Penn Shoulder Score
`Several observations can be made from these charts:
(1) The Penn Shoulder Score data are essentially the same as the ASES data
(2) The tipping point (the average score prior to surgery (see What's the right time to have a shoulder joint replacement arthroplasty? When is it "indicated"? for each of the three groups was the same: 30 points. In other words, patients with OA or CTA turning to arthroplasty typically had only 30% of the patient reported outcome measure.
(3) Both the 1 year score and the percent of maximum possible improvement (see How can we measure whether our patients have benefitted from treatment? Problems with the MCID; benefit of %MPI) were lower for shoulders having cuff tear arthropathy than those having osteoarthritis; whereas the results for patients with OA were essentially the same whether the surgeon chose to perform an aTSA or a rTSA.
(4) No surgeon-controlled variables were identified that correlated with outcome.
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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).
