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Yapp LZ, Clement ND, Scott CEH, Ng N, Breusch HP, MacDonald DJ, Gaston P, Breusch SJ. Long-Term Outcomes of Primary Cemented Total Hip Arthroplasty with Acetabular Bone Graft for Protrusio Acetabuli: Minimum 10-Year Follow-Up. J Clin Med 2024; 13:5612. [PMID: 39337099 PMCID: PMC11432597 DOI: 10.3390/jcm13185612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/12/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024] Open
Abstract
Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan-Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61-75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1-20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan-Meier any-reoperation survival estimate was 91.3% (95% CI 85.9-97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2-98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25-30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06-0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL.
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Affiliation(s)
- Liam Z Yapp
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Nick D Clement
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Chloe E H Scott
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Nathan Ng
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Hanna P Breusch
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Deborah J MacDonald
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Paul Gaston
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
| | - Steffen J Breusch
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SY, UK
- Division of Clinical and Surgical Sciences, Department of Orthopaedics, University of Edinburgh, Chancellors Building, 49 Little France Cres, Edinburgh EH16 4SB, UK
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Wiklund M, Gras A, Hanouz JL, Dunet J, Rochcongar G, Hulet C. The Patient Acceptable Symptom State (PASS) after proximal and distal femoral replacement. Orthop Traumatol Surg Res 2024:103931. [PMID: 38987033 DOI: 10.1016/j.otsr.2024.103931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Femoral megaprostheses are used for bone reconstruction surgery in patients with local tumors or who require multiple revisions. Patient reported outcome measures (PROMs) provide a subjective result and, like patient satisfaction, have become an integral part of the outcomes in orthopedics. However, the threshold of satisfaction (PASS: Patient Acceptable Symptom State) has not yet been defined in a French population after this type of arthroplasty. This led us to carry out a retrospective study on a population of patients who received a femoral reconstruction megaprosthesis in order to 1) define the PASS for the Harris Hip Score (HHS), Knee Society Score (KSS) and the Musculoskeletal Tumor Society score (MSTS), 2) study the complications. HYPOTHESIS The PASS threshold for proximal femur and distal femur reconstruction prothesis for the HHS and the KSS, respectively, will be lower than the threshold for these same scores for primary arthroplasty. MATERIALS AND METHODS Forty-four patients who were operated on between 2009 and 2020 were included: 23 received a proximal femur prosthesis and 21 received a distal femur prosthesis. The PASS threshold was defined using an anchoring strategy by analyzing ROC curves for the HSS for the proximal femur, KSS for the distal femur and the MSTS for all the prostheses. Complications were classified according to Henderson. RESULTS The mean follow-up was 4.5 ± 3.6 (1-12.5) years. The PASS threshold was 47.5 (area under curve (AUC) 0.71 (0.45-0.97)) for the HHS, 69.5 (AUC 0.97 (0.92-1.0)) for the KSS knee and 62.5 (AUC 0.81 (0.61-0.99)) for the KSS function. Thirteen patients (29%) had complications, nine of whom required another surgery (20%). The most frequent were Henderson type 1 (soft tissue lesions, n = 5/44 [11%]) and type 2 (loosening, n = 5/44 [11%]) There was no relationship between satisfaction and postoperative complications (p = 0.071). DISCUSSION Most of the patients who undergo femoral resection and reconstruction (59%) are satisfied with their function, albeit reduced, despite a high complication rate (29%). Our hypothesis is confirmed for the PASS threshold for the HHS (47.5 versus 93) and the KSS knee and function (69.5 and 62.5 versus 85.5 and 72.5). LEVEL OF EVIDENCE IV; retrospective observational single-center study.
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Affiliation(s)
- Marianne Wiklund
- Unit Inserm COMETE, UMR U1075, Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
| | - Arthur Gras
- Unit Inserm COMETE, UMR U1075, Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Jean-Luc Hanouz
- Pôle d'Anesthésie et Réanimation Chirurgicale, Université de Caen Normandie, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Julien Dunet
- Unit Inserm COMETE, UMR U1075, Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Goulven Rochcongar
- Unit Inserm COMETE, UMR U1075, Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Christophe Hulet
- Unit Inserm COMETE, UMR U1075, Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Mooiweer Y, Roling L, Vugrin M, Ansmann L, Stevens M, Seeber GH. Influence of patients' preoperative expectations on postoperative outcomes after total knee or hip arthroplasty: a systematic review. EFORT Open Rev 2024; 9:107-118. [PMID: 38310694 PMCID: PMC10873246 DOI: 10.1530/eor-23-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose The association between preoperative expectations and treatment outcomes in total hip arthroplasty (THA) or total knee arthroplasty (TKA) is still unclear. Therefore the aim is to examine the association between preoperative outcome expectations, process expectations, and self-efficacy, and the postoperative outcomes overall outcome, pain, function, stiffness, satisfaction, and quality of life following THA/TKA. Methods A systematic review with narrative synthesis was conducted. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library were searched from inception to October 17, 2022. Included were prospective longitudinal cohort studies published in English, German, or Dutch, with an adult population undergoing THA/TKA, and including at least one measure of preoperative expectations and the postoperative outcomes mentioned earlier. Two independent reviewers screened the retrieved articles for eligibility, a third solved disagreements. Risk of bias (RoB) was assessed using the QUIPS tool. Results Of the 50 included studies, 38 had high RoB and 12 moderate RoB. Unadjusted results suggest a positive association between preoperative outcome expectations and overall outcome in the medium and long term, and between self-efficacy and change in 'overall outcome' in the long term. Adjusted results suggest positive associations between outcome expectations and function and between self-efficacy and overall outcome in the medium term, and for outcome expectations with pain and change in pain, respectively, and self-efficacy and stiffness in the long term. Conclusions Preoperative expectations show a possible positive association with specific outcome measures, such as pain or function. For future research, it is advised to link matching specific expectations with specific outcomes.
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Affiliation(s)
- Yvet Mooiweer
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lina Roling
- School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Margaret Vugrin
- Preston Smith Library, Texas Tech University Health Sciences Center, Lobbock, Texas, USA
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
- Chair of Medical Sociology, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) Faculty of Medicine, University of Cologne, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
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Yang L, Yang ZY, Li HW, Xu YM, Bian WW, Ruan H. Exploring expectations of Chinese patients for total knee arthroplasty: once the medicine is taken, the symptoms vanish. BMC Musculoskelet Disord 2023; 24:159. [PMID: 36864407 PMCID: PMC9979482 DOI: 10.1186/s12891-023-06251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Preoperative expectations of total knee arthroplasty (TKA) outcomes are important determinants of patient satisfaction. However, expectations of patients in different countries are affected by cultural background. The general goal of this study was to describe Chinese TKA patients' expectations. METHODS Patients scheduled for TKA were recruited in a quantitative study(n = 198). The Hospital for Special Surgery Total Knee Replacement Expectations Survey Questionnaire was used for survey TKA patients' expectations. Descriptive phenomenological design was used for the qualitative research. Semi-structured interviews were conducted with 15 TKA patients. Colaizzi's method was used for interview data analysis. RESULTS The mean expectation score of Chinese TKA patients was 89.17 points. The 4 highest score items were walk short distance, remove the need for walker, relieve pain and make knee or leg straight. The 2 lowest score items were employed for monetary reimbursement and sexual activity. Five main themes and 12 sub-themes emerged from the interview data, including multiple factors raised expectations, expectations of physical comfort, expect various activities back to normal, hope for a long joint lifespan, and expect a better mood. CONCLUSIONS Chinese TKA patients reported a relatively high level of expectations, and differences across cultures result in different expectation points than other national populations, requiring adjustment of items when using assessment tools across cultures. Strategies for expectation management should be further developed. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lin Yang
- grid.16821.3c0000 0004 0368 8293Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293School of Nursing, Shanghai JiaoTong University, Shanghai, China
| | - Zhi-Ying Yang
- grid.16821.3c0000 0004 0368 8293Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hui-Wu Li
- grid.16821.3c0000 0004 0368 8293Department of Orthopedic, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi-Min Xu
- grid.16821.3c0000 0004 0368 8293Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wei-Wei Bian
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Hong Ruan
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Latijnhouwers DAJM, Vlieland TPMV, Marijnissen WJ, Damen PJ, Nelissen RGHH, Gademan MGJ. Sex differences in perceived expectations of the outcome of total hip and knee arthroplasties and their fulfillment: an observational cohort study. Rheumatol Int 2022; 43:911-922. [PMID: 36437310 PMCID: PMC10073060 DOI: 10.1007/s00296-022-05240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Abstract
AbstractThe influence of sex on preoperative expectations and their fulfillment following total hip and knee arthroplasty (THA/TKA) remains unexplored. We investigated differences between men and women in perceived preoperative expectations on the outcome of THA/TKA and their fulfillment 1 year postoperatively. We performed a cohort study. Expectations were collected preoperatively and 1 year postoperatively using the Hospital for Special Surgery Hip/Knee Replacement Expectations Surveys (HSS-HRES/KRES; not applicable = 0, applicable: back to normal = 1, much = 2/moderate = 3/slight improvement = 4). Fulfillment of expectations was calculated by subtracting preoperative from postoperative scores (score < 0:unfulfilled; score ≥ 0:fulfilled). We included patients with “applicable” expectations. Chi-square and ordinal regression were used to compare expectations and fulfillment regarding sex. 2333 THA (62% women) and 2398 TKA (65% women) patients were included. 77% of THA and 76% of TKA patients completed the HSS-HRES/HSS-KRES both preoperatively and 1 year postoperatively. Men more often perceived items as “applicable”, with differences in 9/20 (HSS-HRES) and 9/19 (HSS-KRES) preoperative items and, respectively, 12/20 (HSS-HRES) and 10/19 (HSS-KRES) postoperative items. The largest differences (> 10%) were found in sexual activity and working ability. 16/20 (HSS-HRES) and 14/19 (HSS-KRES) items showed an increased probability of having higher preoperative expectations of ≥ 10%, in favor of men. In all items, 60% of the respondents indicated that their expectation was fulfilled. Differences were observed in 16/20 (HSS-HRES) and 6/19 (HSS-KRES) items in favor of men. Sex differences were present in expectations and fulfillment, with higher applicability of items, preoperative expectations and fulfillment in men, especially on items related to functional activities.Trial registration: Trial-ID NTR3348.
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Affiliation(s)
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Pieter-Jan Damen
- Department of Orthopaedics, Dijklander Hospital, Purmerend, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach-a University clinic case control study of 120 cases. Arch Orthop Trauma Surg 2022; 142:747-754. [PMID: 33386978 DOI: 10.1007/s00402-020-03719-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital. METHODS In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty. RESULTS WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI: - 10.903, - 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI: - 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI: - 5.662, - 0.338; - 6.290, - 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group. CONCLUSION The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Reverse total shoulder arthroplasty for patients with minimal preoperative pain: a matched-cohort analysis. J Shoulder Elbow Surg 2021; 30:609-615. [PMID: 32650079 DOI: 10.1016/j.jse.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Profound improvements in function have been described in patients following reverse total shoulder arthroplasty (RSA). Previous studies have demonstrated young age, high preoperative function, and neurologic dysfunction to be predictors of poor functional improvement. However, no study to date has focused on patients electing to undergo RSA for function more than pain. The purpose of this study was to compare the outcomes of RSA in patients with minimal preoperative pain with those in patients who have higher baseline pain. METHODS We performed a retrospective matched-cohort study of RSA patients treated by a single surgeon with a minimum of 2 years' follow-up. Patients with at least moderate baseline pain (function-pain group), predefined by existing literature as a visual analog scale pain score > 3, were matched 3:1 based on sex, indication, and age to patients with minimal pain (function group), defined as a visual analog scale score ≤ 3. Patient-reported outcome measures, active range of motion, and overall satisfaction were compared. The percentage of maximal improvement in outcomes and the proportion of patients exceeding the established threshold that predicts excellent satisfaction were also compared. RESULTS A total of 260 patients (195 in function-pain group and 65 in function group) were selected for matched analysis with a similar sex distribution; the mean age was 73.1 years, and the mean follow-up period was 50 months. No differences in most recent postoperative function, overall improvement in functional scores, and active motion were found between patients in the 2 groups (P > .05). However, pain scores improved only in patients with at least moderate baseline pain (P < .0001). Patient satisfaction was significantly different (P = .035), as 10.8% of patients who elected to undergo RSA for function were unsatisfied. The function cohort also had worse percentage of maximal Simple Shoulder Test score (P = .034) and American Shoulder and Elbow Surgeons score (P < .0001) improvement, and a lower proportion of these patients exceeded the threshold for the percentage of maximal improvement that predicts an "excellent" outcome (P < .0001). CONCLUSION RSA patients with minimal preoperative pain achieve significant improvements in function and motion similar to those who choose to undergo RSA for both pain and function, but they are less satisfied and are less likely to achieve an excellent outcome. Patients electing to proceed with RSA with minimal pain should be counseled accordingly.
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