PMID- 36681108
OWN - NLM
STAT- MEDLINE
DCOM- 20230320
LR  - 20230320
IS  - 1532-6500 (Electronic)
IS  - 1058-2746 (Linking)
VI  - 32
IP  - 4
DP  - 2023 Apr
TI  - Quantifying success after anatomic total shoulder arthroplasty: the minimal 
      clinically important percentage of maximal possible improvement.
PG  - 688-694
LID - S1058-2746(23)00020-4 [pii]
LID - 10.1016/j.jse.2022.12.012 [doi]
AB  - INTRODUCTION: Changes in pre- to postoperative outcome scores are often used to 
      quantify success after anatomic total shoulder arthroplasty (aTSA). However, 
      ceiling effects associated with many outcome scores limit the ability to 
      differentiate success among high-functioning patients. The percentage maximal 
      possible improvement (%MPI) was introduced to better stratify patient success; 
      however, it is unclear if the 30% threshold first proposed correlates with 
      perceived patient success across all outcome scores. The purpose of this study 
      was to compare the proportion of patients that achieved the minimal clinically 
      important difference (MCID) and %MPI for different outcome scores and to define 
      the %MPI thresholds associated with patient satisfaction following primary aTSA. 
      METHODS: A retrospective review was performed of an international shoulder 
      arthroplasty database between 2003 and 2020. All primary aTSAs performed using a 
      single implant system with minimum 2-year follow-up were reviewed. Pre- and 
      postoperative outcome scores were evaluated for all patients to calculate 
      improvement. The proportion of patients achieving the MCID and 30% MPI were 
      determined for each outcome score. Thresholds for the minimal clinically 
      important %MPI (MCI-%MPI) were calculated using an anchor-based method for each 
      outcome score and stratified by age and sex. RESULTS: 1593 shoulders with a mean 
      follow-up of 59.3 months were included. Outcome scores with known ceiling effects 
      (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons Standardized 
      Shoulder Assessment Form [ASES], University of California-Los Angeles shoulder 
      score [UCLA]) had higher rates of patients achieving the 30% MPI but not the 
      previously reported MCID. Inversely, outcome scores without significant ceiling 
      effects (Constant and Shoulder Arthroplasty Smart [SAS] scores) had higher rates 
      of patients achieving the MCID but not the 30% MPI. The MCI-%MPI differed among 
      outcome scores, and mean values were as follows: 33% for the SST, 24% for the 
      Constant score, 32% for the ASES score, 38% for the UCLA score, 30% for the 
      Shoulder Pain and Disability Index score, and 33% for the SAS score. The MCI-%MPI 
      increased with greater age (P < .003) and females had thresholds greater than or 
      equal to males for all scores assessed, meaning that patients with higher 
      thresholds required a greater fraction of the possible improvement for a given 
      score to be satisfied. CONCLUSION: The %MPI offers a simple method to quickly 
      assess improvements across patient outcome scores. However, the %MPI that 
      represents patient improvement after surgery is not uniformly the previously 
      established 30% threshold. Surgeons should use score-specific estimates of the 
      MCI-%MPI to gauge success when evaluating patients undergoing primary aTSA.
CI  - Copyright (c) 2023. Published by Elsevier Inc.
FAU - Hao, Kevin A
AU  - Hao KA
AD  - College of Medicine, University of Florida, Gainesville, FL, USA.
FAU - Tams, Carl
AU  - Tams C
AD  - Exactech Inc., Gainesville, FL, USA.
FAU - Nieboer, Micah J
AU  - Nieboer MJ
AD  - Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
FAU - King, Joseph J
AU  - King JJ
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Wright, Thomas W
AU  - Wright TW
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Simovitch, Ryan W
AU  - Simovitch RW
AD  - Department of Orthopedic Surgery, Hospital Special Surgery, West Palm Beach, FL, 
      USA.
FAU - Parsons, Moby
AU  - Parsons M
AD  - The Knee, Hip and Shoulder Center, Portsmouth, NH, USA.
FAU - Schoch, Bradley S
AU  - Schoch BS
AD  - Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA. Electronic 
      address: schoch.bradley@mayo.edu.
LA  - eng
PT  - Journal Article
DEP - 20230118
PL  - United States
TA  - J Shoulder Elbow Surg
JT  - Journal of shoulder and elbow surgery
JID - 9206499
SB  - IM
MH  - Male
MH  - Female
MH  - Humans
MH  - *Arthroplasty, Replacement, Shoulder/methods
MH  - *Shoulder Joint/surgery
MH  - Treatment Outcome
MH  - Patient Satisfaction
MH  - Prostheses and Implants
MH  - Retrospective Studies
OTO - NOTNLM
OT  - American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form
OT  - Shoulder Arthroplasty Smart score
OT  - Shoulder replacement
OT  - Simple Shoulder Test
OT  - clinical outcome
OT  - maximal outcome improvement
OT  - patient satisfaction
EDAT- 2023/01/22 06:00
MHDA- 2023/03/21 06:00
CRDT- 2023/01/21 19:23
PHST- 2022/09/19 00:00 [received]
PHST- 2022/11/24 00:00 [revised]
PHST- 2022/12/11 00:00 [accepted]
PHST- 2023/01/22 06:00 [pubmed]
PHST- 2023/03/21 06:00 [medline]
PHST- 2023/01/21 19:23 [entrez]
AID - S1058-2746(23)00020-4 [pii]
AID - 10.1016/j.jse.2022.12.012 [doi]
PST - ppublish
SO  - J Shoulder Elbow Surg. 2023 Apr;32(4):688-694. doi: 10.1016/j.jse.2022.12.012. 
      Epub 2023 Jan 18.