1
|
Smith KL, Karimi A, Harlow ER, Gillespie RJ, Chen RE. Defining patient satisfaction after reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2024; 33:2298-2305. [PMID: 38719073 DOI: 10.1016/j.jse.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The prevalence of reverse total shoulder arthroplasty (rTSA) has grown rapidly. As indications for the procedure expand, the proportion of patients who have satisfactory outcomes after rTSA has not been well defined. This systematic literature review explores overall patient satisfaction after rTSA and defines patient satisfaction based on indication for surgery. METHODS A literature search was performed for studies describing patient satisfaction after rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Papers were included if they investigated patient satisfaction after rTSA at a minimum of 2-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index. Follow-up duration, indication for surgery, and patient reported outcome measures relating to patient satisfaction were also recorded. RESULTS There were a total of 5234 patients and 5288 shoulders from the 45 included studies. The overall study population was 61.2% female and the average age was 71.1 years (range 23-99). Satisfaction results were recorded at final follow-up, with average follow-up of 49.1 months (range 24-228). Overall patient satisfaction ranged from 77.7% to 87.8%, depending on patient satisfaction patient reported outcome measures. When stratified by diagnosis, patients with a diagnosis of glenohumeral osteoarthritis (GHOA) rated better satisfaction on all metrics when compared to patients with a diagnosis of cuff tear arthropathy or massive rotator cuff tear. CONCLUSION This systematic review demonstrated that patients who undergo rTSA for either GHOA, cuff tear arthropathy, or massive rotator cuff tear are generally satisfied with their procedure, with the rate of satisfaction highest in GHOA. Focusing on patient satisfaction may provide the best overall assessment of health care quality in a very understandable and tangible form. Overall satisfaction rate is valuable information for patient education and can be utilized as part of effective surgical counseling.
Collapse
Affiliation(s)
- Kira L Smith
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Amir Karimi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ethan R Harlow
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raymond E Chen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| |
Collapse
|
2
|
Cueto RJ, Hao KA, O’Keefe DS, Mallat MA, Hones KM, Turnbull LM, Wright JO, Soberon J, Schoch BS, King JJ. Clinical outcomes of over-the-top subscapularis repair in reverse shoulder arthroplasty. JSES Int 2024; 8:866-872. [PMID: 39035640 PMCID: PMC11258842 DOI: 10.1016/j.jseint.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Biomechanical research demonstrates increased subscapularis abduction range of motion (ROM) when the tendon's upper two-thirds is repaired over-the-top of the center of rotation during reverse shoulder arthroplasty (RSA). This study compares the clinical outcomes of patients undergoing RSA with over-the-top subscapularis repair (OTTR) to patients without repair. Methods We retrospectively reviewed 97 consecutive RSAs with either OTTR of the subscapularis (N = 75) or no repair (N = 22). Repair was attempted in all patients but not performed if the subscapularis could not be brought to the over-the-top position in 20° of external rotation (ER) and 30° of abduction. Improvements in ROM were compared to the minimal clinically important difference for RSA. Results The mean follow-up was 3.8 ± 1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing repair had greater ER when compared to those without repair (15 ± 16° vs. 5 ± 12°, P = .003). Postoperatively, patients undergoing repair had greater forward elevation (132 ± 21° vs. 126 ± 22°, P = .268) and abduction (114 ± 26° vs. 106 ± 23°, P = .193) with both exceeding the minimal clinically important difference (-2.9° and -1.9°, respectively); however, not statistically significant. Patients with repair were more frequently able to reach the small of their back postoperatively (65% vs. 21%, P = .006) but had less improvement in ER (13 ± 20° vs. 24 ± 20°, P = .028). Postoperative outcome scores, complications, and reoperations were similar between groups. Discussion OTTR of the subscapularis in RSA had similar ROM and outcome scores compared to no repair, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. ER limitations seen after conventional repair may also apply to this novel technique, but without a corresponding detrimental effect on forward elevation or abduction.
Collapse
Affiliation(s)
- Robert J. Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Marlee A. Mallat
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M. Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lacie M. Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O. Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| | - Jose Soberon
- Department of Anesthesiology, North Florida Southern Georgia Veterans Health System, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Bradley S. Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J. King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| |
Collapse
|
3
|
Krupp R, O'Grady C, Werner B, Wiater JM, Nyland J, Duquin T. A two-year comparison of reverse total shoulder arthroplasty mini-humeral tray and augmented mini-glenoid baseplate implants vs. standard implants. Arch Orthop Trauma Surg 2024; 144:1925-1935. [PMID: 38523239 DOI: 10.1007/s00402-024-05276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patients who undergo reverse total shoulder arthroplasty (RTSA) are getting younger with greater function expectations. This retrospective, longitudinal study of prospectively collected data compared perceived shoulder function and strength, active shoulder mobility, radiographic evidence of scapular notching, and implant survival over the initial 2-years post-RTSA among patient groups who received either standard central fixation point liner and glenoid baseplate implants, or lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants. MATERIALS AND METHODS Patients who underwent primary RTSA using standard central fixation point liner and glenoid baseplate implants (Group 1, n = 180) were compared with patients who underwent primary RTSA using lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants (Group 2, n = 53) for active shoulder mobility, American Shoulder and Elbow Surgeons (ASES) score, perceived ability to lift 10 lbs (4.5 kg) overhead, radiographic evidence of scapular notching, and implant survival. Data was collected pre-surgery, 6-weeks, 6-months, 1-year, and 2-years post-RTSA (p ≤ 0.05). RESULTS More Group 2 patients had more complex B or C Walch glenoid morphology, while Group 1 had more A1 or A2 types (p ≤ 0.001). Group 2 had greater active shoulder flexion at 6-months, 1-year, and 2-years (p ≤ 0.018) and external rotation (in adduction) at 6-months and 2-years (p ≤ 0.004) compared to Group 1, with higher ASES scores at 6-months and 2-years (p ≤ 0.026) (with small-to-medium effect sizes), and with more patients meeting or exceeding the minimal clinically important difference (MCID) at 2-years (p = 0.045) and patient acceptable symptomatic state (PASS) levels at 6-months, 1-year and 2-years (p ≤ 0.045). Scapular notching was identified in six of 53 (11.3%) Group 2 patients and in 32 of 180 (17.7%) Group 1 patients. Group 1 patients had more grade 2 or greater scapular notching grades compared to Group 2 (p = 0.04). Implant survival was comparable with Group 1 = eight of 180 (4.4%) and Group 2 = 1 of 53 (1.9%) of patients requiring removal for 95.6% and 98.1% implant survival, respectively. CONCLUSION Limited scapular notching and excellent implant survival was observed in both groups. Despite including individuals with more complex glenoid deficiency, patients receiving the lower size profile implants generally displayed better active shoulder mobility and perceived shoulder function compared to those who received standard implants. These patients also more frequently met or exceeded the MCID by 2-years post-RTSA and PASS levels by 6-months, 1-year, and 2-years post-RTSA, with lower scapular notching grades. LEVEL OF EVIDENCE Retrospective comparative study.
Collapse
Affiliation(s)
- Ryan Krupp
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA
| | | | - Brian Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - John Nyland
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
| | - Thomas Duquin
- Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
4
|
Blasco JM, Navarro-Bosch M, Aroca-Navarro JE, Hernández-Guillén D, Puigcerver-Aranda P, Roig-Casasús S. A Virtual Assistant to Guide Early Postoperative Rehabilitation after Reverse Shoulder Arthroplasty: A Pilot Randomized Trial. Bioengineering (Basel) 2024; 11:152. [PMID: 38391638 PMCID: PMC10885890 DOI: 10.3390/bioengineering11020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Rehabilitation can improve outcomes after reverse shoulder arthroplasty (RSA). However, low adherence to rehabilitation and compliance rates are some of the main barriers. To address this public health issue, the goal of this research was to pilot test and evaluate the effectiveness of a chatbot to promote adherence to home rehabilitation in patients undergoing RSA. METHODS A randomized pilot trial including patients undergoing RSA and early postoperative rehabilitation was performed. The control group received standard home rehabilitation; the experimental group received the same intervention supervised with a chatbot, with automated interactions that included messages to inform, motivate, and remember the days and exercises for 12 weeks. Compliance with rehabilitation and clinical measures of shoulder function, pain, and quality of life were assessed. RESULTS 31 patients (17 experimental) with an average age of 70.4 (3.6) completed the intervention. Compliance was higher in the experimental group (77% vs. 65%; OR95% = 2.4 (0.5 to 11.4)). Statistically significant between-group differences with a CI of 95% were found in the QuickDASH questionnaire and self-reported quality of life. No differences were found in the rest of the measures. CONCLUSIONS This pilot study suggests that the chatbot tool can be useful in promoting compliance with early postoperative home rehabilitation in patients undergoing RSA. Future randomized trials with adequate power are warranted to determine the clinical impact of the proposal.
Collapse
Affiliation(s)
- José-María Blasco
- Group in Physiotherapy of the Ageing Processes-Social and Healthcare Strategies, Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Marta Navarro-Bosch
- Orthopedic and Trauma Surgery Service, Hospital Universitari i Politècnic La Fe de València, 46026 Valencia, Spain
| | - José-Enrique Aroca-Navarro
- Orthopedic and Trauma Surgery Service, Hospital Universitari i Politècnic La Fe de València, 46026 Valencia, Spain
| | - David Hernández-Guillén
- Group in Physiotherapy of the Ageing Processes-Social and Healthcare Strategies, Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | - Sergio Roig-Casasús
- Group in Physiotherapy of the Ageing Processes-Social and Healthcare Strategies, Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Orthopedic and Trauma Surgery Service, Hospital Universitari i Politècnic La Fe de València, 46026 Valencia, Spain
| |
Collapse
|
5
|
Mocini F, Cerciello S, Corona K, Morris BJ, Saturnino L, Giordano MC. The effect of subscapularis repair in reverse total shoulder arthroplasty depends on the design of the implant: a comparative study with a minimum 2-year follow-up. Arch Orthop Trauma Surg 2024; 144:41-49. [PMID: 37596498 DOI: 10.1007/s00402-023-05025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION The role of the subscapularis (Ssc) tendon does not yet have a well-defined role in RSA. The purpose of the present study was to evaluate if the repair of the Ssc in RSA improves overall clinical and radiographic results and if it has the same results using a medialized design humeral stem compared to a lateralized design. METHODS Eighty-four consecutive patients undergoing RSA were retrospectively analyzed. Nine patients were lost at FU. Two implants with similar glenosphere design and different stem design (medialized and lateralized) were used. The Ssc was repaired in case of good quality of the fibers and reducibility without tension intraoperatively. Patients were divided into four groups for data analysis depending on whether they had received a medialized or lateralized design and Ssc repair or not. Patients were reviewed at an average follow-up of 40.8 ± 13.1 months. Clinical outcome measures included Active range of motion (ROM), strength, visual analog scale (VAS), Constant-Murley score (CMS), and the American Shoulder and Elbow Surgeons score (ASES). Radiographic evaluation at final follow-up was performed to assess scapular notching, stress shielding, and radiolucent lines. RESULTS No statistically significant clinical differences (p > 0.05) emerged between Lat/Ssc+ and Lat/Ssc-. Conversely, the patients belonging to the Med/Ssc- group reported statistically worse (p < 0.05) results than the Med/Ssc + group in terms of VAS, ASES and CMS. Statistically worse (p < .05) results in the Med/Ssc- group than in the Med/Ssc + were found also in active ROM achieved in FE, ABD, ER1 and ER2, and in the strength obtained in FE, ABD and ER2. Scapular notching was reported in 3 shoulders (15.7%) in Lat/Ssc+ group and in 7 shoulders (50%) in Lat/Ssc- group, while it was reported in 4 shoulders (14.2%) in Med/Ssc + group and in 6 shoulders (42.8%) in Med/Ssc- group. Stress shielding was observed in 6 cases in Lat/Ssc+ group (31.6%), in 8 cases in Lat/Ssc- group (57.1%), in 3 cases (10.7%) in Med/Ssc + group and 4 cases in Med/Ssc- group (28.6%). CONCLUSIONS Patients undergoing RSA show clinical improvements at mid-term follow-up with a low rate of complications, regardless of the use of a medialized or a lateralized humeral stem design. Ssc repair is associated with better functional outcomes in the cohort of medialized stem, while it did not yield significant differences in the cohort of lateralized stem. LEVEL OF EVIDENCE Level III; Retrospective Cohort Comparison; Treatment Study.
Collapse
Affiliation(s)
| | - Simone Cerciello
- Casa di Cura Villa Betania, Rome, Italy
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Brent J Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
| | | | | |
Collapse
|
6
|
Sweeney BM, Sadhwani SD, Kendall MS, Kelly MJ. Treatment of coronal split glenoid fracture utilizing open reduction internal fixation with immediate intraoperative conversion to rTSA: a novel approach. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:534-539. [PMID: 37928997 PMCID: PMC10625000 DOI: 10.1016/j.xrrt.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Brendan M. Sweeney
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
| | - Shaan D. Sadhwani
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
| | - Matthew S. Kendall
- Orthopedic Surgery Residency, UPMC Central Pa., Harrisburg Campus, Harrisburg, PA, USA
| | | |
Collapse
|