PMID- 33711501 OWN - NLM STAT- MEDLINE DCOM- 20211025 LR - 20211025 IS - 1532-6500 (Electronic) IS - 1058-2746 (Linking) VI - 30 IP - 11 DP - 2021 Nov TI - Patients undergoing anatomic total shoulder arthroplasty achieve clinically significant outcomes faster than those undergoing reverse shoulder arthroplasty. PG - 2523-2532 LID - S1058-2746(21)00156-7 [pii] LID - 10.1016/j.jse.2021.02.015 [doi] AB - BACKGROUND: Clinically significant outcome (CSO) benchmarks have been previously established for outcome assessment after total shoulder arthroplasty. However, the time required to achieve CSO improvement is not well understood. The purpose of this study was to (1) determine the time-dependent achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) in patients undergoing either anatomic total shoulder (TSA) or reverse total shoulder arthroplasty (RTSA) and compare the results of the 2 populations and (2) identify variables associated with earlier or delayed achievement of each CSO. METHODS: A prospectively maintained institutional registry was retrospectively queried for all patients receiving a primary TSA or RTSA between September 2, 2016-October 31, 2017. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was administered to all patients preoperatively and at standardized postoperative time periods: 5-7 months (6-month time point), 11-13 months (1-year time point), and 23-25 months (2-year time point). Cumulative percentages of CSO achievement were calculated using Kaplan-Meier survival curve analysis with interval censoring. A Weibull parametric survival regression analysis was used to investigate the influence of demographic and clinical variables on delayed or earlier CSO achievement. RESULTS: A total of 153 patients (157 shoulders) undergoing TSA (n = 76) and RTSA (n = 81) were included in the study population. The RTSA cohort was older (70.2 +/- 7.5 vs. 61.0 +/- 8.4, P < .001), had a lower BMI (28.8 +/- 5.9 vs. 31.5 +/- 6.5, P = .006), and a greater proportion of females (53.1% vs. 32.9%, P = .017) relative to TSA. For SCB, there was a significant difference in the cumulative percentage of TSA and RTSA patients reaching this threshold at both the 6-month (77.3% vs. 59.0%, P = .024) and 2-year (92.0% vs. 79.5%, P = .048) time periods, with similar findings demonstrated for PASS. There was a significant difference in the average time required to achieve the PASS (TSA: 6.1 months vs. rTSA: 11.6 months, P = .009), but not the MCID (P = .407) or SCB (P = .153). Factors significantly associated with earlier achievement of more than 1 of the CSO benchmarks were regular preoperative physical exercise and diagnosis of rotator cuff tear without osteoarthritis. CONCLUSION: Patients undergoing RTSA had lower rates of achieving SCB and PASS at both 6 months and 2 years compared to patients undergoing TSA. Patients undergoing RTSA on average required nearly double the time to achieve PASS compared with those undergoing TSA. In both groups, clinically significant improvement continued for the entire 2-year duration of study follow-up. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Drager, Justin AU - Drager J AD - Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA. FAU - Polce, Evan M AU - Polce EM AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Fu, Michael AU - Fu M AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Nemsick, Michael AU - Nemsick M AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Huddleston, Hailey P AU - Huddleston HP AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Forsythe, Brian AU - Forsythe B AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Nicholson, Gregory P AU - Nicholson GP AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Cole, Brian J AU - Cole BJ AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Verma, Nikhil N AU - Verma NN AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. FAU - Garrigues, Grant E AU - Garrigues GE AD - Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA. Electronic address: grant.garrigues@rushortho.com. LA - eng PT - Journal Article DEP - 20210309 PL - United States TA - J Shoulder Elbow Surg JT - Journal of shoulder and elbow surgery JID - 9206499 SB - IM MH - *Arthroplasty, Replacement, Shoulder MH - Female MH - Humans MH - Retrospective Studies MH - Rotator Cuff/surgery MH - *Shoulder Joint/surgery MH - Treatment Outcome OTO - NOTNLM OT - Clinically significant outcomes OT - Kaplan-Meier survival curve OT - Weibull parametric survival regression OT - total shoulder arthroplasty EDAT- 2021/03/13 06:00 MHDA- 2021/10/26 06:00 CRDT- 2021/03/12 20:16 PHST- 2020/10/18 00:00 [received] PHST- 2021/02/06 00:00 [revised] PHST- 2021/02/13 00:00 [accepted] PHST- 2021/03/13 06:00 [pubmed] PHST- 2021/10/26 06:00 [medline] PHST- 2021/03/12 20:16 [entrez] AID - S1058-2746(21)00156-7 [pii] AID - 10.1016/j.jse.2021.02.015 [doi] PST - ppublish SO - J Shoulder Elbow Surg. 2021 Nov;30(11):2523-2532. doi: 10.1016/j.jse.2021.02.015. Epub 2021 Mar 9.