PMID- 38461936
OWN - NLM
STAT- Publisher
LR  - 20240310
IS  - 1532-6500 (Electronic)
IS  - 1058-2746 (Linking)
DP  - 2024 Mar 8
TI  - Stratification of the Minimal Clinically Important Difference, Substantial 
      Clinical Benefit, and Patient Acceptable Symptomatic State after Total Shoulder 
      Arthroplasty by Implant Type, Preoperative Diagnosis, and Sex.
LID - S1058-2746(24)00159-9 [pii]
LID - 10.1016/j.jse.2024.01.040 [doi]
AB  - BACKGROUND: Clinical significance, as opposed to statistical significance, has 
      increasingly been utilized to evaluate outcomes after total shoulder arthroplasty 
      (TSA). The purpose of this study was to identify thresholds of the minimal 
      clinically important difference (MCID), substantial clinical benefit (SCB), and 
      patient acceptable symptomatic state (PASS) for TSA outcome metrics and determine 
      if these thresholds are influenced by prosthesis type (anatomic or reverse TSA), 
      sex, or preoperative diagnosis. METHODS: A prospectively collected international 
      multicenter database inclusive of 38 surgeons was queried for patients receiving 
      a primary aTSA or rTSA between 2003 and 2021. Prospectively, outcome metrics 
      including ASES, shoulder function score (SFS), SST, UCLA, Constant, VAS Pain, 
      shoulder arthroplasty smart (SAS) score, forward flexion, abduction, external 
      rotation, and internal rotation was recorded preoperatively and at each 
      follow-up. A patient satisfaction question was administered at each follow-up. 
      Anchor-based MCID, SCB, and PASS were calculated as defined previously overall 
      and according to implant type, preoperative diagnosis, and sex. The percentage of 
      patients achieving thresholds was also quantified. RESULTS: A total of 5,851 
      total shoulder arthroplasties including aTSA (n=2,236) and rTSA (n=3,615) were 
      included in the study cohort. The following were identified as MCID thresholds 
      for the overall (aTSA + rTSA irrespective of diagnosis or sex) cohort: VAS Pain 
      (-1.5), SFS (1.2), SST (2.1), Constant (7.2), ASES (13.9), UCLA (8.2), SPADI 
      (-21.5), and SAS (7.3), Abduction (13 degrees ), Forward elevation (16 degrees ), External 
      rotation (4 degrees ), Internal rotation score (0.2). SCB thresholds for the overall 
      cohort were: VAS Pain (-3.3), SFS (2.9), SST 3.8), Constant (18.9), ASES (33.1), 
      UCLA (12.3), SPADI (-44.7), and SAS (18.2), Abduction (30 degrees ), Forward elevation 
      (31 degrees ), External rotation (12 degrees ), Internal rotation score (0.9). PASS thresholds 
      for the overall cohort were: VAS Pain (0.8), SFS (7.3), SST (9.2), Constant 
      (64.2), ASES (79.5), UCLA (29.5), SPADI (24.7), and SAS (72.5), Abduction (104 degrees ), 
      Forward elevation (130 degrees ), External rotation (30 degrees ), Internal rotation score (3.2). 
      MCID, SCB, and PASS thresholds varied depending on preoperative diagnosis and 
      sex. CONCLUSION: MCID, SCB, and PASS thresholds vary depending on implant type, 
      preoperative diagnosis, and sex. A comprehensive understanding of these 
      differences as well as identification of clinically-relevant thresholds for 
      legacy and novel metrics is essential to assist surgeons in evaluating their 
      patient's outcomes, interpreting the literature, and counseling their patients 
      preoperatively regarding expectations for improvement. Given that PASS thresholds 
      are fragile and vary greatly depending on cohort variability, caution should be 
      exercised in conflating them across different studies.
CI  - Copyright (c) 2024. Published by Elsevier Inc.
FAU - Simovitch, Ryan W
AU  - Simovitch RW
AD  - Hospital for Special Surgery, West Palm Beach, FL, USA.
FAU - Elwell, Josie
AU  - Elwell J
AD  - Exactech, Inc., Gainesville, FL, USA.
FAU - Colasanti, Christopher A
AU  - Colasanti CA
AD  - NYU Langone Orthopedic Hospital, New York, NY, USA.
FAU - Hao, Kevin A
AU  - Hao KA
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Friedman, Richard J
AU  - Friedman RJ
AD  - Medical University of South Carolina, Charleston, SC, USA.
FAU - Flurin, Pierre-Henri
AU  - Flurin PH
AD  - Department of Orthopaedic Surgery, Clinique du Sport de Bordeaux-Merignac, 
      Merignac, France.
FAU - Wright, Thomas W
AU  - Wright TW
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Schoch, Bradley S
AU  - Schoch BS
AD  - Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
FAU - Roche, Christopher P
AU  - Roche CP
AD  - Exactech, Inc., Gainesville, FL, USA.
FAU - Zuckerman, Joseph D
AU  - Zuckerman JD
AD  - NYU Langone Orthopedic Hospital, New York, NY, USA. Electronic address: 
      simovitchr@hss.edu.
LA  - eng
PT  - Journal Article
DEP - 20240308
PL  - United States
TA  - J Shoulder Elbow Surg
JT  - Journal of shoulder and elbow surgery
JID - 9206499
SB  - IM
OTO - NOTNLM
OT  - ATSA
OT  - MCID
OT  - PASS
OT  - RTSA
OT  - SCB
OT  - anatomic total shoulder arthroplasty
OT  - reverse total shoulder arthroplasty
EDAT- 2024/03/11 00:42
MHDA- 2024/03/11 00:42
CRDT- 2024/03/10 20:14
PHST- 2023/10/06 00:00 [received]
PHST- 2024/01/02 00:00 [revised]
PHST- 2024/01/18 00:00 [accepted]
PHST- 2024/03/11 00:42 [medline]
PHST- 2024/03/11 00:42 [pubmed]
PHST- 2024/03/10 20:14 [entrez]
AID - S1058-2746(24)00159-9 [pii]
AID - 10.1016/j.jse.2024.01.040 [doi]
PST - aheadofprint
SO  - J Shoulder Elbow Surg. 2024 Mar 8:S1058-2746(24)00159-9. doi: 
      10.1016/j.jse.2024.01.040.