PMID- 38218402
OWN - NLM
STAT- Publisher
LR  - 20240428
IS  - 1532-6500 (Electronic)
IS  - 1058-2746 (Linking)
DP  - 2024 Jan 12
TI  - Clinically significant outcome thresholds and rates of achievement by shoulder 
      arthroplasty type and preoperative diagnosis.
LID - S1058-2746(24)00024-7 [pii]
LID - 10.1016/j.jse.2023.11.023 [doi]
AB  - BACKGROUND: Clinically significant outcome (CSO) benchmarks have been previously 
      established for shoulder arthroplasty by assimilating preoperative diagnoses and 
      arthroplasty types. The purpose of this study was to establish unique CSO 
      thresholds and compare the time-to-achievement of these for reverse shoulder 
      arthroplasty (RSA) for osteoarthritis (GHOA), RSA for rotator cuff arthropathy 
      (RCA), and total shoulder arthroplasty (TSA) for GHOA. MATERIALS AND METHODS: 
      Consecutive patients who underwent elective RSA for GHOA, TSA for GHOA, or RSA 
      for RCA between February 2015 and May 2020, with 2-year minimum follow-up, were 
      retrospectively identified from a prospectively maintained single surgeon 
      registry. The American Shoulder and Elbow Surgeons (ASES) score was administered 
      preoperatively and postoperatively at 2-week, 6-week, 3-month, 6-month, 1-year, 
      and 2-year timepoints. Satisfaction and subjective overall improvement anchor 
      questionnaires were administered at the time of final follow-up. 
      Distribution-based methods were used to calculate the Minimal Clinically 
      Important Difference (MCID), and anchor-based methods were used to calculate the 
      Substantial Clinical Benefit (SCB) and the Patient Acceptable Symptom State 
      (PASS) for each patient group. Median time to achievement, individual incidence 
      of achievement at each time point, and cumulative incidence of achievement 
      calculated using Kaplan-Meier survival curve analysis with interval censoring 
      were compared between groups for each CSO. Cox-regression analyses were also 
      performed to determine which patient factors were significantly associated with 
      early or delayed achievement of CSOs. RESULTS: There were 471 patients eligible 
      for study analysis: 276 RSA for GHOA, 107 TSA for GHOA, and 88 RSA for RCA. The 
      calculated MCID, SCB, and PASS scores differed for each group. There were no 
      significant differences in median time to achievement of any CSO between groups. 
      Log-rank testing revealed that cumulative achievements significantly differed 
      between groups for MCID (P = .014) but not for SCB (P = .053) or PASS (P = .620). 
      On cox regression analysis, TSA patients had earlier achievement of SCB, whereas 
      TSA and RSA for GHOA patients had earlier achievement of MCID. At 2-years, a 
      significantly higher percentage of RSA for GHOA patients achieved MCID and SCB 
      compared to RSA for RCA (MCID:100%, 95.5%, P = .003, SCB:94.6%, 86.4%, P = .036). 
      CONCLUSION: Calculated CSO thresholds differ according to preoperative diagnosis 
      and shoulder arthroplasty type. Patients undergoing TSA and RSA for GHOA achieve 
      CSOs earlier than RSA for RCA patients, and a significantly higher percentage of 
      RSA for GHOA patients achieve CSOs by 2 years compared to RSA for RCA patients.
CI  - Copyright (c) 2024. Published by Elsevier Inc.
FAU - Puzzitiello, Richard N
AU  - Puzzitiello RN
AD  - Department of Orthopedics, Tufts Medical Center, Boston, MA, USA.
FAU - Moverman, Michael A
AU  - Moverman MA
AD  - Department of Orthopedics, Tufts Medical Center, Boston, MA, USA.
FAU - Glass, Evan A
AU  - Glass EA
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
FAU - Swanson, Daniel P
AU  - Swanson DP
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
FAU - Bowler, Adam R
AU  - Bowler AR
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
FAU - Le, Kiet
AU  - Le K
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
FAU - Kirsch, Jacob M
AU  - Kirsch JM
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
FAU - Lohre, Ryan
AU  - Lohre R
AD  - Department of Orthopedic Surgery, Massachusetts General Hospital, Boston Shoulder 
      Institute, Boston, MA, USA.
FAU - Jawa, Andrew
AU  - Jawa A
AD  - Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; 
      Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA. 
      Electronic address: andrewjawa@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20240112
PL  - United States
TA  - J Shoulder Elbow Surg
JT  - Journal of shoulder and elbow surgery
JID - 9206499
SB  - IM
OTO - NOTNLM
OT  - MCID
OT  - PASS
OT  - Reverse total shoulder arthroplasty
OT  - SCB
OT  - anatomic total shoulder arthroplasty
OT  - glenohumeral osteoarthritis
OT  - rotator cuff arthropathy
OT  - shoulder replacement
EDAT- 2024/01/14 12:42
MHDA- 2024/01/14 12:42
CRDT- 2024/01/13 19:32
PHST- 2023/07/26 00:00 [received]
PHST- 2023/11/14 00:00 [revised]
PHST- 2023/11/19 00:00 [accepted]
PHST- 2024/01/14 12:42 [pubmed]
PHST- 2024/01/14 12:42 [medline]
PHST- 2024/01/13 19:32 [entrez]
AID - S1058-2746(24)00024-7 [pii]
AID - 10.1016/j.jse.2023.11.023 [doi]
PST - aheadofprint
SO  - J Shoulder Elbow Surg. 2024 Jan 12:S1058-2746(24)00024-7. doi: 
      10.1016/j.jse.2023.11.023.