PMID- 37178967 OWN - NLM STAT- MEDLINE DCOM- 20230919 LR - 20230919 IS - 1532-6500 (Electronic) IS - 1058-2746 (Linking) VI - 32 IP - 10 DP - 2023 Oct TI - Quantifying success after first revision reverse total shoulder arthroplasty: the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state. PG - e516-e527 LID - S1058-2746(23)00365-8 [pii] LID - 10.1016/j.jse.2023.03.032 [doi] AB - BACKGROUND: When patients require revision of primary shoulder arthroplasty, revision reverse total shoulder arthroplasty (rTSA) is most commonly performed. However, defining clinically important improvement in these patients is challenging because benchmarks have not been previously defined. Our purpose was to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for outcome scores and range of motion (ROM) after revision rTSA and to quantify the proportion of patients achieving clinically relevant success. METHODS: This retrospective cohort study used a prospectively collected single-institution database of patients undergoing first revision rTSA between August 2015 and December 2019. Patients with a diagnosis of periprosthetic fracture or infection were excluded. Outcomes scores included the ASES, raw and normalized Constant, SPADI, SST, and University of California, Los Angeles (UCLA) scores. ROM measures included abduction, forward elevation (FE), external rotation (ER), and internal rotation (IR) score. Anchor-based and distribution-based methods were used to calculate the MCID, SCB, and PASS. The proportions of patients achieving each threshold were assessed. RESULTS: Ninety-three revision rTSAs with minimum 2-year follow-up were evaluated. Mean age was 67 years, 56% were female, and average follow-up was 54 months. Revision rTSA was performed most commonly for failed anatomic TSA (n = 47), followed by hemiarthroplasty (n = 21), rTSA (n = 15), and resurfacing (n = 10). The indication for revision rTSA was most commonly glenoid loosening (n = 24), followed by rotator cuff failure (n = 23), subluxation and unexplained pain (n = 11 for both). The anchor-based MCID thresholds (% of patients achieving) were as follows: ASES, 20.1 (42%); normalized Constant, 12.6 (80%); UCLA, 10.2 (54%); SST, 0.9 (78%); SPADI, -18.4 (58%); abduction, 13 degrees (83%); FE, 18 degrees (82%); ER, 4 degrees (49%); and IR, 0.8 (34%). The SCB thresholds (% of patients achieving) were as follows: ASES, 34.1 (25%); normalized Constant, 26.6 (43%); UCLA, 14.1 (28%); SST, 3.9 (48%); SPADI, -36.4 (33%); abduction, 20 degrees (77%); FE, 28 degrees (71%); ER, 15 degrees (15%); and IR, 1.0 (29%). The PASS thresholds (% of patients achieving) were as follows: ASES, 63.5 (53%); normalized Constant, 59.1 (61%); UCLA, 25.4 (48%); SST, 7.0 (55%); SPADI, 42.4 (59%); abduction, 98 degrees (61%); FE, 110 degrees (56%); ER, 19 degrees (73%); and IR, 3.3 (59%). CONCLUSIONS: This study establishes thresholds for the MCID, SCB, and PASS at minimum 2-years after revision rTSA, providing physicians an evidence-based method to counsel patients and assess patient outcomes postoperatively. CI - Published by Elsevier Inc. FAU - Hao, Kevin A AU - Hao KA AD - College of Medicine, University of Florida, Gainesville, FL, USA. FAU - Hones, Keegan M AU - Hones KM AD - College of Medicine, University of Florida, Gainesville, FL, USA. FAU - O'Keefe, Daniel S AU - O'Keefe DS AD - College of Medicine, University of Florida, Gainesville, FL, USA. FAU - Saengchote, Supreeya A AU - Saengchote SA AD - College of Medicine, University of Florida, Gainesville, FL, USA. FAU - Burns, Madison Q AU - Burns MQ AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Wright, Jonathan O AU - Wright JO 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 - Farmer, Kevin W AU - Farmer KW AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Struk, Aimee M AU - Struk AM AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Simovitch, Ryan W AU - Simovitch RW AD - Hospital for Special Surgery Florida, West Palm Beach, FL, USA. FAU - Schoch, Bradley S AU - Schoch BS 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. Electronic address: kingjj@ortho.ufl.edu. LA - eng PT - Journal Article DEP - 20230511 PL - United States TA - J Shoulder Elbow Surg JT - Journal of shoulder and elbow surgery JID - 9206499 SB - IM MH - Humans MH - Female MH - Aged MH - Male MH - *Arthroplasty, Replacement, Shoulder/adverse effects MH - *Shoulder Joint/surgery MH - Retrospective Studies MH - Minimal Clinically Important Difference MH - Treatment Outcome MH - Range of Motion, Articular OTO - NOTNLM OT - MCID OT - PASS OT - Reverse shoulder arthroplasty OT - SCB OT - anchor OT - distribution OT - inverted shoulder OT - shoulder replacement EDAT- 2023/05/14 01:07 MHDA- 2023/09/19 06:43 CRDT- 2023/05/13 19:28 PHST- 2023/01/09 00:00 [received] PHST- 2023/03/08 00:00 [revised] PHST- 2023/03/22 00:00 [accepted] PHST- 2023/09/19 06:43 [medline] PHST- 2023/05/14 01:07 [pubmed] PHST- 2023/05/13 19:28 [entrez] AID - S1058-2746(23)00365-8 [pii] AID - 10.1016/j.jse.2023.03.032 [doi] PST - ppublish SO - J Shoulder Elbow Surg. 2023 Oct;32(10):e516-e527. doi: 10.1016/j.jse.2023.03.032. Epub 2023 May 11.