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Jochl OM, Afetse EK, Garg S, Kanakamedala AC, Lind DR, Hinz M, Rizzo M, Millett PJ, Ruzbarsky J, Provencher MT. The impact of mental health conditions on clinical and functional outcomes after shoulder arthroplasty: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:371-378. [PMID: 39157244 PMCID: PMC11329040 DOI: 10.1016/j.xrrt.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background Shoulder arthroplasty (SA) has been shown to improve quality of life, though outcomes may vary between individuals. Multiple factors may affect outcomes, including preoperative mental health conditions (MHCs). The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients with MHC compared to patients without MHC. Methods This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE was conducted from inception until September 2023 to obtain studies reporting outcomes after total shoulder arthroplasty and reverse total shoulder arthroplasty in patients with and without MHC. Study characteristics and information on clinical and functional outcomes were collected. All included studies were case-control studies. The methodological quality of the included primary studies was appraised using the methodological index for nonrandomized studies scoring. Results Eleven articles published between 2016 and 2023 met inclusion criteria. In total, 49,187 patients, 49,289 shoulders, and five different MHC were included. 8134 patients in the cohort had a diagnosed MHC. The mean patient age was 67.8 years (range, 63.5-71.6 years), and 52.6% of the patients were female. The mean follow-up time was 35.5 months (range, 16.2-58.3 months). Reverse total shoulder arthroplasty was the most common type of procedure (25,543 shoulders, 51.8%). Depression and anxiety were the most reported psychiatric diagnoses (7990 patients, 98.2%). Patients with versus without MHC reported mean improvements of 38 and 42 in American Shoulder and Elbow Surgeons shoulder score and mean Visual Analog Scale pain improvements of 4.7 and 4.9, respectively. Mean complication rates of 31.4% and 14.2% were observed in patients with versus without MHC, respectively. The most prevalent surgical complication in patients with MHC was infection (1.8%), followed by prosthetic complication (1.7%), and adhesive capsulitis (1.6%). Conclusions Patients with MHC may have lower preoperative range of motion, worse postoperative shoulder function, and higher postoperative pain levels than patients without MHC. Patients with MHC demonstrated improvements in range of motion and functional outcomes after SA but had higher reported complication and revision rates when compared to patients without MHC. Depression and anxiety were the leading conditions correlated with lower outcomes in patients with MHC after SA. Preoperative physical therapy, mental health counseling, and expectation setting may help these patients reach the maximal achievable benefit from SA.
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Affiliation(s)
| | | | - Sahil Garg
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Ajay C. Kanakamedala
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | | | - Maximilian Hinz
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Michael Rizzo
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Joseph Ruzbarsky
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Davies AR, Sabharwal S, Reilly P, Sankey RA, Griffiths D, Archer S. Factors influencing patient decision-making to undergo shoulder arthroplasty. Bone Jt Open 2024; 5:543-549. [PMID: 38955355 PMCID: PMC11219201 DOI: 10.1302/2633-1462.57.bjo-2024-0009.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Aims Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients' decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research. Methods Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached. Results Two overall categories emerged: the motivations to consider surgery, and the information participants used to inform their decision-making. Motivations were, broadly, the relief of pain and the opportunity to get on with life and regain independence. When participants' symptoms and restrictions prevented them enjoying life to a sufficient extent, this provided the motivation to proceed with surgery. Younger participants tended to focus on maintaining employment and recreational activities, and older patients were eager to make the most of their remaining lifetime. Participants gathered information from a range of sources and were keen to optimize their recovery where possible. An important factor for participants was whether they trusted their surgeon and were prepared to delegate responsibility for elements of their care. Conclusion Relief of pain and the opportunity to get on with life were the primary reasons to undergo shoulder arthroplasty. Participants highlighted the importance of the patient-surgeon relationship and the need for accurate information in an accessible format which is relevant to people of different ages and functional demands.
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Affiliation(s)
- Andrew R. Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - R. A. Sankey
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Dylan Griffiths
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Stephanie Archer
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Karpinski K, Plachel F, Gerhardt C, Saier T, Tauber M, Auffarth A, Paksoy A, Akgün D, Moroder P. Comparison of Patients' and Surgeons' Expectations before Shoulder Arthroplasty. J Clin Med 2024; 13:3489. [PMID: 38930018 PMCID: PMC11204657 DOI: 10.3390/jcm13123489] [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: 03/26/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Patients suffering from osteoarthritis particularly complain about pain during day and night as well as loss of function. This consequently leads to impaired quality of life and therefore psychological stress. The surgical therapy of choice is joint replacement. Regarding the outcome after operation, expectations might differ between the patient and the surgeon. This can lead to dissatisfaction on both sides. This study aimed to document patients' expectations of a planned shoulder joint replacement. The results were compared with assessments made by shoulder surgeons. Methods: In total, 50 patients scheduled for operative shoulder joint replacement were included in this study, as well as 10 shoulder surgeons. Patients were requested to fill out questionnaires preoperatively to provide sociodemographic data, PROMS (Patient-Reported Outcome Measures) with regard to the pathology and their expectations about surgery in terms of pain relief, gain of range of motion, strength as well as the impact on activities of daily and professional life and sports. In addition, surgeons were asked what they thought their patients expect. Results: The most important goal to achieve for patients was to relieve daytime pain, followed by improvement of self-care and the ability to reach above shoulder level. The most important factors for patients to achieve after operation were 'pain relief' in first place, 'movement' in second and 'strength' in third. This also applied to shoulder surgeons, who ranked 'pain relief' first, followed by 'movement' and 'strength'. When patients where asked what is most important when it comes to choosing their surgeon, 68% voted for 'surgical skills', 28% for 'age/experience', followed by 'empathy', 'sympathy' and 'appearance'. For surgeons, 'age/experience' obtained rank one, 'surgical skills' was ranked second, followed by 'sympathy', 'empathy' and 'appearance'. Surgeons significantly underrated the factor 'empathy' in favor of 'sympathy'. Conclusions: This study shows that patients' expectations for shoulder joint replacement and surgeons' assessments do not differ significantly. Relief from pain and better shoulder movement were crucial for patients to achieve after operation, which was in line with surgeons' expectations. The most important factor for choosing the surgeon was 'surgical skills' for patients, while surgeons thought they would care more about 'age and experience'. This underlines that patients' expectations should be taken into account within the preoperative medical interview. This might allow an optimization of compliance of the patients and lead to a better satisfaction on both sides.
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Affiliation(s)
- Katrin Karpinski
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Fabian Plachel
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | | | - Tim Saier
- BG Unfallklinik Murnau, 82418 Murnau am Staffelsee, Germany
| | | | - Alexander Auffarth
- Universitätsklinik für Orthopädie und Traumatologie, Universitätsklinikum Salzburg, A-5020 Salzburg, Austria;
| | - Alp Paksoy
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Doruk Akgün
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Philipp Moroder
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Kuijpers TIM, Vossen RJM, Kuijer PPFM, Alta TD, Sierevelt IN, Van Noort A. Return-to-work following shoulder arthroplasty in adults with osteoarthritis. Occup Med (Lond) 2023; 73:339-345. [PMID: 37471472 DOI: 10.1093/occmed/kqad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Anatomic total shoulder arthroplasty (aTSA) and hemiarthroplasty (HA) have demonstrated significant improvement in shoulder function and pain relief. Work-related outcomes have become increasingly important, while the current literature lacks evidence related to return-to-work (RTW) and which factors might have an influence on it. AIMS This study aimed to assess RTW in patients who have received aTSA or HA at a minimum of 1-year follow-up after surgery, and secondary to evaluate possible prognostic factors associated with RTW. METHODS We performed a retrospective query in employed patients diagnosed with primary osteoarthritis of the shoulder, who received either an aTSA or HA between February 2006 and February 2021. Preoperative and post-operative work and sports participation were assessed. RESULTS Forty-four patients participated in this study (98% compliance), of which 40 patients (91%) were able to RTW at a median time of two (interquartile range: 2-4) months post-operatively. Patients with a medium-/high-demand occupation demonstrated RTW at a significantly lower rate (79%) than those with light-demand occupations (100%; P = 0.03). There was a statistically significant association between return to full employment and patients' expectation to fully return, absence of preoperative work adjustments and preoperative sick leave (odds ratio: 16.9 [3.1-93.5]; 18.3 [2.1-160.4]; 0.1 [0.0-0.6]). CONCLUSIONS aTSA and HA facilitate excellent RTW rates. Patients with a medium-/high-demand occupation return at a significantly lower rate. The ability to RTW seems to be multifactorial and the results found might not be attributed to shoulder arthroplasty alone.
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Affiliation(s)
- T I M Kuijpers
- Orthopedics Department, Spaarne Gasthuis, 2134TM, Hoofddorp, The Netherlands
| | - R J M Vossen
- Orthopedics Department, Spaarne Gasthuis, 2134TM, Hoofddorp, The Netherlands
| | - P P F M Kuijer
- Public and Occupational Health Department, Amsterdam UMC, 1105AZ, Amsterdam, The Netherlands
| | - T D Alta
- Orthopedics Department, Spaarne Gasthuis, 2134TM, Hoofddorp, The Netherlands
| | - I N Sierevelt
- Orthopedics Department, Spaarne Gasthuis, 2134TM, Hoofddorp, The Netherlands
| | - A Van Noort
- Orthopedics Department, Spaarne Gasthuis, 2134TM, Hoofddorp, The Netherlands
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Perception of Goals and Expected Outcomes in Older Hip Fracture Patients and Their Medical Staff: A Cross Sectional Study. Geriatr Orthop Surg Rehabil 2023; 14:21514593231202735. [PMID: 37744458 PMCID: PMC10517609 DOI: 10.1177/21514593231202735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Goal-oriented patientcare is a key element in qualityhealthcare. Medical-caregiver's (MC) are expected to generate a shared decision-making process with patients regarding goals and expected health-outcomes. Hip-fracture patients (HFP) are usually older-adults with multiple health-conditions, necessitating that agreed-upon goals regarding the rehabilitation process, take these conditions into consideration. This topic has yet to be investigated by pairing and comparing the perception of expected outcomes and therapeutic goals of multidisciplinary MCs and their HF patient's. Our aim was to assess in a quantitative method whether HFPs and their multidisciplinary MCs agree upon target health-outcomes and their most important goals as they are reflected in the SF12 questionnaire. Methods This was a cross-sectional, multi-center, study of HFPs and their MCs. Patients and MCs were asked to rate their top three most important goals for rehabilitation from the SF12 eight subscales: physical functioning, physical role limitation, bodily pain, general health, vitality, social functioning, emotional role limitation and mental health, and indicate their expected outcome. Descriptive statistics and mixed effect logistic-regression were used to compare concordance of the ratings. Agreement between patients and MCs was assessed using interclass coefficients (ICCs). Results A total of 378 ratings were collected from 52 patients, 12 nurses, 12 physicians and 6 paramedical personnel. Each patient had between 3 and 9 raters. Patients considered physical functioning and physical role limitation more important than did MCs. Physicians and nurses emphasized the importance of bodily pain while patients referred to it as relatively less significant. The total ICC was low (2%) indicating poor agreement between MCs and patients. With the exception of physical-functioning, MCs predicted a less optimistic outcome in all of the SF12's subscales in comparison to HFPs. Conclusion Effective intervention in HFPs requires constructive communication between MCs and patients. The study suggests that caregivers have an insufficient understanding of the expectations of HFPs. More effective communication channels are required in order to better understand HFPs' needs and expectations.
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Affiliation(s)
- Hanna S. Schroeder
- Department of Nursing at the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
- Israel Ministry of Health, Jerusalem, Israel
| | - Meir (Iri) Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Wiessam Abu Ahmed
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Central Management, Sheba Medical Center, Ramat-Gan, Israel
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İlyas G, Egeli E. Does Reverse Shoulder Arthroplasty Improve Function and Quality of Life in Patients With Rotator Cuff Tear Arthropathy? Cureus 2023; 15:e42896. [PMID: 37664251 PMCID: PMC10474821 DOI: 10.7759/cureus.42896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background This study aims to determine the change in functional capacity and quality of life in patients who underwent reverse shoulder arthroplasty (RSA) due to rotator cuff tear arthropathy (RCTA). Methodology A total of 89 patients who underwent RSA due to RCTA between 2016 and 2022 were included in the study, as examined by the senior author. The Constant-Murley Score (CMS) was used for functional assessment, whereas the Short Form-36 (SF-36) was used for quality-of-life evaluation. The assessment scores before and after the surgery were compared to the reference values of CMS and SF-36 scores, as determined by reference studies, based on age groups. The change in functional capacity and quality of life with RSA was calculated. In addition, the impact of age and body mass index (BMI) on the results was examined. Results No differences were found in demographic data except for BMI (p = 0.026). CMS did not reach the reference values of a normal shoulder during the 12-month postoperative period. However, a significant increase of 156% in comparison to the preoperative values was detected (p < 0.001). In the postoperative period, there was a statistically significant improvement in SF-36 scores compared to preoperative scores, except for social functioning (p = 0.099) and vitality (p = 0.255) (for all other parameters, p < 0.001). In patients under the age of 65 years, all parameters except for physical functioning, physical role, and social functioning statistically reached the reference values. A decrease in CMS scores was noted with an increase in BMI, and the negative correlation further increased in the postoperative period (preoperative: r = -0.274, 12-month postoperative: r = -0.476). Conclusions RSA performed for RCTA leads to an improvement in functional outcomes and quality of life. Although there was a considerable improvement after surgery for CMS compared to preoperatively, it was observed that normal shoulder reference values could not be reached. For SF-36, it was observed that it reached normal shoulder reference values, especially in patients over 65 years of age.
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Affiliation(s)
- Gökhan İlyas
- Orthopedics and Traumatology, Uşak University, Uşak, TUR
| | - Ercument Egeli
- Orthopedics and Traumatology, Uşak Esme State Hospital, Uşak, TUR
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Hill BW, Joyce CD, Singh A, Guttman MJ, Williams GR, Namdari S. Patients With Mild Osteoarthritis Are Less Likely to Achieve a Clinically Important Improvement in Pain or Function After Anatomic Total Shoulder Arthroplasty. Clin Orthop Relat Res 2023; 481:1464-1470. [PMID: 36853879 PMCID: PMC10344495 DOI: 10.1097/corr.0000000000002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The severity of glenohumeral osteoarthritis (OA) as demonstrated by preoperative radiographs and patient-reported pain plays an important role in the indication for anatomic total shoulder arthroplasty (aTSA). In hip and knee research, data about the effect of the severity of preoperative radiographic OA on the outcome of total joint arthroplasty have been mixed. For shoulder replacement, we are unsure of the effects of radiographic severity on outcomes. QUESTIONS/PURPOSES This study investigated whether the preoperative radiographic severity of glenohumeral OA is associated with improvement in pain and function after aTSA. We asked, (1) does the severity of glenohumeral OA correlate with improvement in patient-reported outcomes after TSA (delta American Shoulder and Elbow Surgeons score [postoperative-preoperative], delta Single Assessment Numeric Evaluation, delta Simple Shoulder Test, and delta VAS)? (2) Is having mild osteoarthritis associated with not meeting the minimum clinically important differences in preoperative and postoperative American Shoulder and Elbow Surgeons scores? METHODS An institutional query of patients who underwent aTSA for OA was performed between January 2015 and December 2018. A total of 1035 patients were eligible; however, only patients with adequate preoperative radiographs and patient-reported outcome measures collected preoperatively and at a minimum of 2 years postoperatively were included. Patients with proximal humerus fractures, inflammatory arthropathy, cuff tear arthropathy, prior ipsilateral rotator cuff repair, brachial plexus injury or neuromuscular disorder, workers compensation, periprosthetic joint infection, or revision surgery within 2 years were excluded. Patient characteristics, comorbidities, and prior shoulder surgery were recorded. The severity of OA was classified based on the modified Samilson-Prieto and Walch classification. The association between Samilson-Prieto grade and patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and VAS score) was evaluated. Radiographic characteristics, patient demographics, comorbidities, and prior surgery were also evaluated for the potential risk of not achieving improvement in the minimum clinically important difference (16.1) with respect to the American Shoulder and Elbow Surgeons score. The American Shoulder and Elbow Surgeons score is scored 0 to 100, with higher scores representing less pain and better function. A total of 206 patients (20% of those eligible) with a mean follow-up of 2.3 years were included. Twenty-three patients had Samilson-Prieto Grade I, 38 had Grade II, 57 had Grade III, and 88 had Grade IV. RESULTS There were no differences in improvements (delta) between the groups and between patient-reported outcome scores (American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and VAS). Compared with patients with more severe osteoarthritis (Samilson-Prieto Grades II, III, and IV), a higher proportion of patients with less severe osteoarthritis (Grade I) did not exceed the minimum clinical important difference for the American Shoulder and Elbow Surgeons score (22% [five of 23] versus 4% [seven of 183]; odds ratio 0.14 [95% confidence interval 0.04 to 0.520]; p = 0.006). CONCLUSION The improvement in patient-reported outcome measure scores was similar regardless of radiographic severity after aTSA. Surgeons should use caution when recommending surgery to patients with less severe OA because a higher percentage did not improve, based on the minimum clinically important difference. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Brian W. Hill
- Palm Beach Orthopaedic Institute, Palm Beach Gardens, FL, USA
| | | | - Arjun Singh
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J. Guttman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R. Williams
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Geyer D, Vessey JA, Chen A, DiFazio RL. Parental Caregiver Expectations and Satisfaction Following Hip Reconstruction and Spinal Fusion in Children With Cerebral Palsy. Orthop Nurs 2023; 42:94-102. [PMID: 36944203 DOI: 10.1097/nor.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Children with severe (Gross Motor Function Classification System [GMFCS] IV-V) cerebral palsy (CP) exhibit profound physical and developmental impairments and require assistance for all activities of daily living. No curative treatments exist although surgical procedures to correct underlying hip and spine deformities can improve their quality of life. Despite the efficacy of these surgeries, little is known regarding parental caregivers' expectations specific to surgical outcomes and their satisfaction with surgical outcomes. The purpose was to explore parental caregiver expectations and satisfaction with hip and spine surgeries that their children with GMFCS IV-V CP underwent. Variations among preoperative expectations, changes in expectations over time, and the relationship of expectations on caregiver satisfaction were examined. A qualitative descriptive approach with conventional content analysis was utilized. Three preoperative caregiver expectation themes were identified: increasing functionality, increasing comfort, and maintaining health and averting crisis. These themes were still present at 5-year follow-up; however, more caregivers refocused their expectations from improving function to providing palliation. A clear relationship between expectations and caregiver satisfaction, however, was not identified. A deeper understanding surrounding caregiver expectation and satisfaction following surgical procedures is needed.
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Affiliation(s)
- David Geyer
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Judith A Vessey
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Anna Chen
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Rachel L DiFazio
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
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Higher preoperative expectations predict better outcomes in shoulder surgery patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:185-192. [PMID: 35780400 DOI: 10.1007/s00167-022-07053-9] [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: 02/18/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study is to determine if preoperative expectations (PE) are an independent predictor of greater 2-year outcomes and greater improvement from baseline in shoulder surgery patients. METHODS Two-hundred and sixteen patients who underwent shoulder surgery at one institution were studied. Patients completed both preoperative and 2-year follow-up questionnaires including PROMIS (Patient-Reported Outcome Measurement Information System) computer-adaptive testing in six domains, American Shoulder and Elbow Surgeons (ASES) score, shoulder numeric pain scale (NPS), and the Marx Shoulder Activity Rating Scale (MARS). PE were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) expectations domain, and satisfaction was measured via the Surgical Satisfaction Questionnaire (SSQ-8). RESULTS The mean PE score was 86.2 ± 17.8. Greater PE were associated with significantly better 2-year scores for ASES, NPS, MARS, SSQ8, and PROMIS domains of Physical Function, Fatigue, Pain Interference Fatigue and Social Satisfaction. Multivariable analyses demonstrated that greater PE were an independent predictor of both better 2-year scores and greater improvement for PROMIS SS (p < 0.001), ASES (p = 0.007), and shoulder NPS (p = 0.011). CONCLUSION Greater PE are positively associated with numerous patient-based outcomes 2 years after surgery. With regards to pain relief, shoulder function, and social satisfaction, higher PE are also predictive of better outcome scores and more improvement. This study suggests that preoperative assessment of shoulder surgery PE is important, and that counseling patients to optimize realistic expectations may lead to superior outcomes. LEVEL OF EVIDENCE III.
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11
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Schwank A, Struyf T, Struyf F, Blazey P, Mertens M, Gisi D, Pisan M, Meeus M. Are psychosocial variables, sleep characteristics or central pain processing prognostic factors for outcome following rotator cuff repair? A protocol for a prospective longitudinal cohort study. BMJ Open 2022; 12:e058803. [PMID: 35926993 PMCID: PMC9358941 DOI: 10.1136/bmjopen-2021-058803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Prognosis following surgical rotator cuff repair (RCR) is often established through the assessment of non-modifiable biomedical factors such as tear size. This understates the complex nature of recovery following RCR. There is a need to identify modifiable psychosocial and sleep-related variables, and to find out whether changes in central pain processing influence prognosis after RCR. This will improve our knowledge on how to optimise recovery, using a holistic rehabilitation approach. METHODS AND ANALYSIS This longitudinal study will analyse 141 participants undergoing usual care for first time RCR. Data will be collected 1-21 days preoperatively (T1), then 11-14 weeks (T2) and 12-14 months (T3) postoperatively. We will use mixed-effects linear regression to assess relationships between potential prognostic factors and our primary and secondary outcome measures-the Western Ontario Rotator Cuff Index; the Constant-Murley Score; the Subjective Shoulder Value; Maximal Pain (Numeric Rating Scale); and Quality of Life (European Quality of Life, 5 dimensions, 5 levels). Potential prognostic factors include: four psychosocial variables; pain catastrophising, perceived stress, injury perceptions and patients' expectations for RCR; sleep; and four factors related to central pain processing (central sensitisation inventory, temporal summation, cold hyperalgesia and pressure pain threshold). Intercorrelations will be assessed to determine the strength of relationships between all potential prognostic indicators.Our aim is to explore whether modifiable psychosocial factors, sleep-related variables and altered central pain processing are associated with outcomes pre-RCR and post-RCR and to identify them as potential prognostic factors. ETHICS AND DISSEMINATION The results of the study will be disseminated at conferences such as the European Pain Congress. One or more manuscripts will be published in a peer-reviewed SCI-ranked journal. Findings will be reported in accordance with the STROBE statement and PROGRESS framework. Ethical approval is granted by the Ethical commission of Canton of Zurich, Switzerland, No: ID_2018-02089 TRIAL REGISTRATION NUMBER: NCT04946149.
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Affiliation(s)
- Ariane Schwank
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Institute for Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Thomas Struyf
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Struyf
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Paul Blazey
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michel Mertens
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - David Gisi
- Institute for Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Markus Pisan
- Orthopaedics and Traumatology, Shoulder and Elbow Unit, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Mira Meeus
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
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Ahmed R, Lanham NS, Peterson JR, Jobin CM, Levine WN. Characterization of ASES score pain and functional improvement after anatomic total shoulder arthroplasty: a patient-centered perspective. J Shoulder Elbow Surg 2022; 31:1042-1046. [PMID: 34808350 DOI: 10.1016/j.jse.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Interpretation of anchor-based clinical differences in the context of pain and functional change remains undefined. The purpose of this study was to characterize American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores for patients after anatomic total shoulder arthroplasty with minimum 1 year of follow-up in terms of pain and change in each functional element on the ASES. METHODS We performed a retrospective study of a prospective institutional patient database of primary anatomic total shoulder arthroplasties from 2017-2020 with baseline and 1-year postoperative ASES scores. Three clinical outcome groups were established using an anchor-based global rating of change assessment: minimal clinically important difference (MCID), moderate clinical benefit (MCB), and substantial clinical benefit (SCB). Pain and functional outcomes in each group where then characterized and compared. RESULTS A total of 67 patients were analyzed in terms of demographics and clinical outcomes. Two-thirds (65%) of patients achieved the SCB, 24% achieved the MCB, and 10% achieved the MCID. Washing, reaching for a shelf, and throwing were the most common functional deficits experienced preoperatively and accounted for the largest improvement in function postoperatively. Patients in the MCID group had higher preoperative visual analog scale (VAS) pain scores (7.1 ± 3.0) than the MCB (5.8 ± 2.5) or SCB (5.8 ± 2.2) groups (P = .0612). The MCID group had the least amount of preoperative functional deficits when compared to the MCB and SCB groups (P = .041). Postoperative VAS pain scores improved by 5.1 in the SCB, 3.6 in the MCB, and 3.7 in the MCID groups. Functional change in each element of the ASES improved by 1.4/4 in the SCB, followed by 0.9/4 in the MCB group and 0.05/4 in the MCID group (P < .001). CONCLUSION The MCID group had higher preoperative pain scores and the least amount of preoperative functional deficits when compared to the MCB and SCB groups. The MCID was realized through pain improvement only, whereas the MCB and SCB consisted of meaningful improvements in pain and function.
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Affiliation(s)
- Rifat Ahmed
- Department of Orthopedic Surgery, Division of Shoulder Elbow and Sports Medicine (SESM), Columbia University Medical Center, New York, NY, USA
| | - Nathan S Lanham
- Department of Orthopedic Surgery, Division of Shoulder Elbow and Sports Medicine (SESM), Columbia University Medical Center, New York, NY, USA.
| | - Joel R Peterson
- Department of Orthopedic Surgery, Division of Shoulder Elbow and Sports Medicine (SESM), Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Division of Shoulder Elbow and Sports Medicine (SESM), Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Division of Shoulder Elbow and Sports Medicine (SESM), Columbia University Medical Center, New York, NY, USA
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Altintas B, Horan MP, Dornan GJ, Pogorzelski J, Godin JA, Millett PJ. The Recovery Curve of Anatomic Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis: Mid-term Results at a Minimum of 5 Years. JSES Int 2022; 6:587-595. [PMID: 35813142 PMCID: PMC9264145 DOI: 10.1016/j.jseint.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA. Methods Patients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed. Linear mixed-effects models were used to model progression in PROs longitudinally. Unadjusted models and models controlling for sex and age were constructed. Results Eighty-one patients (91 shoulders) were included. Significant improvements from the preoperative period to 1 year postoperatively in the median American Shoulder and Elbow Surgeons (48 to 93; P < .001), Quick Disabilities of the Arm Shoulder and Hand Score (42 to 11; P < .001), Single Assessment Numeric Evaluation (50 to 91; P < .001), and Short-Form 12 Physical Component Summary (35 to 53; P = .004) scores were noted. No significant decrease was observed for any of the outcome scores. Median satisfaction at the final follow-up was 10 out of 10. At 1, 2, 3, 4, 5, 6, and 7 years postoperatively, 77%, 64%, 79%, 57%, 86%, 56%, and 78% of patients, respectively, reported sports participation equal to or slightly below preinjury level. There was no association between the glenoid morphology and functional outcomes. Conclusion Patients undergoing anatomic TSA for primary GHOA showed excellent improvement in PROs and satisfaction in the first year, and these results were maintained postoperatively for a minimum of 5 years. Age- and sex-adjusted models or glenoid morphology did not substantially alter any trends in PROs postoperatively.
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Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonathan A. Godin
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
- Corresponding author: Peter J. Millett, MD, MSc, Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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Characterizing preoperative expectations for patients undergoing reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:537-544. [PMID: 34619351 DOI: 10.1016/j.jse.2021.08.030] [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: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There remains a paucity of information analyzing which factors most influence preoperative expectations for patients undergoing reverse total shoulder arthroplasty (RTSA). The purposes of our study were to characterize preoperative patient expectations for those scheduled to undergo RTSA and to determine the impact of demographic factors, shoulder function, and shoulder pain on these preoperative expectations. METHODS Patients were prospectively recruited into the study if they were scheduled to undergo an elective unilateral primary RTSA for a diagnosis of glenohumeral arthritis. Preoperative patient expectations were evaluated using the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Patients also completed the American Shoulder and Elbow Surgeons shoulder score, the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function-Upper Extremity computer adaptive test (version 2.0), the PROMIS Pain Interference (PI) computer adaptive test (version 1.1), the PROMIS Depression computer adaptive test (version 1.0), visual analog scores, and an itemized satisfaction questionnaire, which paralleled the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Demographic data and preoperative shoulder range of motion (ROM) were also recorded. RESULTS A total of 107 patients scheduled to undergo RTSA were included in the study. Relief of daytime pain (n = 91, 85%), improvement in self-care (n = 86, 80%), and improvement in shoulder ROM (n = 85, 79%) were most commonly cited as "very important" expectations. In the item-specific analysis, lower PROMIS Upper Extremity scores were correlated with greater expectations for the ability to reach sideways (P = .015) and the ability to perform daily activities (P = .018). Patients with lower shoulder ROM had greater expectations for improved shoulder ROM (internal rotation with arm at 90°, P = .004) and an improved ability to perform daily activities (forward elevation, P = .038; abduction, P = .009). In the cumulative analysis, a greater number of very important expectations was associated with African American race (P = .013), higher PROMIS PI score (r = 0.351, P = .004), and lower overall preoperative satisfaction (r = 0.334, P < .001). CONCLUSION Patients scheduled to undergo RTSA have the greatest expectations for relief of daytime pain, improvement in self-care, and improvement in shoulder ROM. Patients with limited preoperative ROM have greater expectations for improvement in self-care and the ability to perform daily activities in addition to expectations for improvement in shoulder ROM. Greater overall expectations for surgery were not associated with preoperative physical function but were instead associated with lower preoperative satisfaction and higher PROMIS PI scores.
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Mathew JI, Nicholson AD, Finocchiaro A, Okeke L, Dines DM, Dines JS, Taylor SA, Warren RF, Gulotta LV. Outcomes of shoulder arthroplasty by year of index procedure: are we getting better? J Shoulder Elbow Surg 2022; 31:245-251. [PMID: 34592407 DOI: 10.1016/j.jse.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether postoperative patient-reported outcomes improved over time following anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). METHODS We performed a retrospective analysis of prospectively collected patient-reported outcomes from our institution's registry between 2008 and 2018 (N = 1899). American Shoulder and Elbow Surgeons (ASES) scores at a minimum of 2 years postoperatively were required. Univariable linear models were used to test the association between year of surgery and improvement in ASES scores at 2- and 5-year follow-up, as well as any association with age, sex, primary or revision surgery, hand dominance, American Society of Anesthesiologists classification, rotator cuff status, primary diagnosis, and Walch classification. Multivariable models were created to analyze ASES score improvement by index year while controlling for significant factors. RESULTS In the univariable analysis, 5-year ASES difference scores increased each year by a mean of 1.65 (P < .001; 95% confidence interval [CI], 0.75-2.55) for TSA, 2.50 (P = .014; 95% CI, 0.52-4.49) for RTSA, and 1.64 (P < .001; 95% CI, 0.81-2.47) for the overall population. Patient sex, American Society of Anesthesiologists classification, rotator cuff status, primary diagnosis, Walch classification, and revision procedures were also significant factors affecting ASES scores. On multivariable analysis controlling for these factors, 5-year ASES difference scores were still significantly associated with year of surgery, increasing each year by a mean of 2.20 (P < .001; 95% CI, 0.91-3.50) for TSA, 4.83 (P < .001; 95% CI, 1.17-8.49) for RTSA, and 1.66 (P < .001; 95% CI, 0.81-2.51) for the entire population. CONCLUSION Both anatomic TSA and RTSA patients reported increasing ASES difference scores at 5-year follow-up as time passed. These findings may indicate that advances in shoulder arthroplasty have resulted in better patient outcomes over time. Further research is needed to clarify which factors influence improvements in outcomes, particularly for revision procedures.
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Measuring Patient Value after Total Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10235700. [PMID: 34884402 PMCID: PMC8658226 DOI: 10.3390/jcm10235700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Evaluating the value of health care is of paramount importance to keep improving patients' quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter's formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6-2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7-1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5-2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, -0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value.
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Baessler AM, Brolin TJ, Azar FM, Sen S, Chang M, Falkner D, Zmistowski BM, Routman HD, Namdari S, Gulotta LV, Throckmorton TW. Development and validation of a predictive model for outcomes in shoulder arthroplasty: a multicenter analysis of nearly 2000 patients. J Shoulder Elbow Surg 2021; 30:2698-2702. [PMID: 34284093 DOI: 10.1016/j.jse.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Guiding expectations following shoulder arthroplasty is important in improving patient satisfaction. The purpose of this study was to develop a predictive model to calculate 2-year American Shoulder and Elbow Surgeons (ASES) scores in shoulder arthroplasty patients from a comprehensive set of preoperative patient factors and types of arthroplasty performed. METHODS This retrospective multicenter study included 1947 shoulder arthroplasties performed from 2010 to 2015 at 3 high-volume centers. Twenty-six variables were evaluated for an association with 2-year ASES scores, and variables with P < .20 in our pair-wise analysis were used to develop a predictive model. The prediction root-mean-square error was calculated. External validation was performed using data from 233 patients who underwent shoulder arthroplasty performed by a separate shoulder surgeon at a center not involved with creation of the predictive model. RESULTS A total of 1947 patients were analyzed, and their data were used to construct the predictive model. Variables most associated with 2-year ASES scores were patient age, preoperative ASES score, disability, chronic obstructive pulmonary disease, alcohol use, anatomic vs. reverse total shoulder arthroplasty, and primary vs. revision shoulder arthroplasty. By use of cross validation, the prediction error was 20.1, the proportion of variance explained was 25.3%, the mean absolute error was 15.9, and the C statistic for the linear regression model was 0.66. After external validation, the mean difference between predicted and actual 2-year ASES scores was 12.7 points, within the accepted minimal clinically important difference after shoulder arthroplasty. DISCUSSION Data from nearly 2000 shoulder arthroplasties allowed the development and validation of a model to predict 2-year ASES scores following shoulder arthroplasty. The model was accurate within the minimal clinically important difference in 85% of patients.
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Affiliation(s)
- Aaron M Baessler
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Saunak Sen
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael Chang
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dmitri Falkner
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence V Gulotta
- Department of Orthopedic Surgery, Hospital for Special Surgery-Weill Cornell Medical School, New York, NY, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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Chawla SS, Whitson AJ, Schiffman CJ, Matsen FA, Hsu JE. Drivers of lower inpatient hospital costs and greater improvements in health-related quality of life for patients undergoing total shoulder and ream-and-run arthroplasty. J Shoulder Elbow Surg 2021; 30:e503-e516. [PMID: 33271324 DOI: 10.1016/j.jse.2020.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND With increasing emphasis on value-based care and the heavy demands on the US health care budget, surgeons must be cognizant of factors that drive cost and quality of patient care. Our objective was to determine patient-level drivers of lower costs and improved health-related quality of life (HRQoL) in 2 anatomic shoulder arthroplasty procedures: total shoulder arthroplasty (TSA) and ream-and-run arthroplasty. METHODS This study included 222 TSAs and 211 ream-and-run arthroplasties. Simple Shoulder Test, Single Assessment Numeric Evaluation, and Short Form 36 scores were collected preoperatively and 2 years postoperatively. Quality-adjusted life-years (QALYs) were calculated as a measure of HRQoL. Univariate and multivariate analyses determined factors significantly associated with decreased hospitalization costs and improved HRQoL. RESULTS In the TSA group, female sex, lower American Society of Anesthesiologists class, diagnosis other than capsulorrhaphy arthropathy, lower pain score, and higher Single Assessment Numeric Evaluation score were associated with decreased total hospitalization costs; in addition, female sex was an independent predictor of lower total costs. Insurance other than workers' compensation, a diagnosis of chondrolysis, and higher optimism led to greater QALY gains, but a diagnosis of capsulorrhaphy arthropathy was the only independent predictor of greater QALY gains. In the ream-and-run arthroplasty group, older age, lower body mass index (BMI), lower American Society of Anesthesiologists class, insurance other than Medicaid, diagnosis other than capsulorrhaphy arthropathy, no history of surgery, higher preoperative Simple Shoulder Test score, and higher preoperative Short Form 36 Physical Component Summary score were associated with lower total costs; moreover, lower BMI was an independent predictor of lower costs. Higher preoperative optimism was an independent predictor of greater QALY gains. CONCLUSIONS Identifying factors associated with decreased costs and increased quality is becoming increasingly important in value-based care. This study identified fixed (sex and diagnosis) and modifiable (BMI) factors that drive decreased hospitalization costs and increased HRQoL improvements in shoulder arthroplasty patients. Higher preoperative patient optimism is a consistent predictor of improved HRQoL for both TSA patients and ream-and-run arthroplasty patients, and further study on optimizing the influence of patient expectations and optimism may be warranted.
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Affiliation(s)
- Sagar S Chawla
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Factors Contributing to Lingering Pain after Surgery: The Role of Patient Expectations. Anesthesiology 2021; 134:915-924. [PMID: 33831145 DOI: 10.1097/aln.0000000000003754] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain that lingers beyond the early weeks after the acute postoperative period is an important risk factor for chronic postsurgical pain. This study examined the hypothesis that patients' expectations about their postsurgical pain would be independently associated with lingering postsurgical pain. METHODS The study included 3,628 patients who underwent diverse surgeries between February 2015 and October 2016 in a single U.S. tertiary hospital and participated in the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) observational study. Preoperatively, patients were asked about their expectations about pain 1 month after surgery. Patients were considered to have lingering postsurgical pain if they endorsed having pain in the area related to their surgeries during a follow-up survey obtained 1 to 3 months postoperatively. The independent associations between preselected perioperative variables and lingering postsurgical pain were evaluated. RESULTS Of the cohort, 36% (1,308 of 3,628) experienced lingering postsurgical pain. Overall, two thirds (2,414 of 3,628) expected their postsurgical pain to be absent or improved from baseline, and 73% of these had their positive expectations fulfilled. A total of 19% (686 of 3,628) expected new, unabated, or worsened pain, and only 39% (257 of 661) of these had their negative expectations fulfilled. Negative expectations were most common in patients with presurgical pain unrelated to the reason for surgery, undergoing surgeries not typically performed to help alleviate pain. Endorsing negative expectations was independently associated with lingering postsurgical pain (odds ratio, 1.56; 95% CI, 1.23 to 1.98; P < 0.001). Additional major factors associated with lingering postsurgical pain included recollection of severe acute postoperative pain (odds ratio, 3.13; 95% CI, 2.58 to 3.78; P < 0.001), undergoing a procedure typically performed to help alleviate pain (odds ratio, 2.18; 95% CI, 1.73 to 2.75; P < 0.001), and preoperative pain related to surgery (odds ratio, 1.91; 95% CI, 1.52 to 2.40; P < 0.001). CONCLUSIONS Lingering postsurgical pain is relatively common after diverse surgeries and is associated with both fixed surgical characteristics and potentially modifiable factors like pain expectations and severe acute postoperative pain. EDITOR’S PERSPECTIVE
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20
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Lawrence C, Lazarus M, Abboud J, Williams G, Namdari S. Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty. JOINTS 2021; 7:159-164. [PMID: 34235380 PMCID: PMC8253618 DOI: 10.1055/s-0041-1730982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 04/18/2021] [Indexed: 10/31/2022]
Abstract
Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA ( p = 0.024) and younger age ( p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES ( p = 0.004) and SANE ( p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score ( p = 0.01) and SANE score ( p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.
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Affiliation(s)
- Cassandra Lawrence
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Mark Lazarus
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Joseph Abboud
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gerald Williams
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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21
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Nadarajah V, Meredith SJ, Jauregui JJ, Smuda MP, Medina S, Gilotra MN, Hasan SA, Henn RF. Preoperative opioid use in patients undergoing shoulder surgery. Shoulder Elbow 2021; 13:248-259. [PMID: 34659464 PMCID: PMC8512997 DOI: 10.1177/1758573219879689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioids are commonly used to manage pain from acute injury or chronic degenerative diseases. The objective of this study was to assess the prevalence of preoperative opioid use in patients undergoing shoulder surgery and the clinical factors associated with preoperative opioid use. METHODS This was an analytical cross-sectional study of 175 patients undergoing shoulder surgery at an urban hospital from June 2015 to June 2017. Multivariable regression models were used to determine independent associations. RESULTS Fifty-three patients reported preoperative opioid use, which was significantly associated with primary procedure performed (Current Procedural Terminology [CPT]), higher body mass index (BMI), unemployment, lower income, smoking, higher American Society of Anesthesiologists score, greater number of previous surgeries, higher comorbidity burden, and decreased expectations to exercise and do recreational activities (p < 0.05). Preoperative opioid use was independently associated with worse scores on the: Numeric Pain Scale, ASES, IPAQ, and PROMIS domains of Physical Function, Pain Interference, and Social Satisfaction (p < 0.05). CONCLUSION More than one in four patients reported preoperative opioid use. Several health measures, including worse pain, function, and social satisfaction were independently associated with preoperative opioid use. These findings suggest that orthopaedic surgeons need to identify patients using opioids preoperatively in order to effectively establish and execute a plan for pain management, which may include weaning off opioids prior to surgery, managing psychological distress, and optimizing coping strategies.Level of Evidence: III.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and
Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Shaun Medina
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
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22
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Stevens KN, Nadarajah V, Jauregui JJ, Song X, Medina SH, Smuda MP, Packer JD, Henn RF. Preoperative Expectations of Patients Undergoing Knee Surgery. J Knee Surg 2021; 34:612-620. [PMID: 31639850 DOI: 10.1055/s-0039-1698805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7-89.3) and median of 91.7 (95% CI, 89.2-94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The level of evidence for the study is IV.
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Affiliation(s)
- Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate College of Medicine, Brooklyn, New York
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xuyang Song
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shaun H Medina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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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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McLendon PB, Christmas KN, Simon P, Plummer OR, Hunt A, Ahmed AS, Mighell MA, Frankle MA. Machine Learning Can Predict Level of Improvement in Shoulder Arthroplasty. JB JS Open Access 2021; 6:e20.00128. [PMID: 34386682 PMCID: PMC8352606 DOI: 10.2106/jbjs.oa.20.00128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The ability to accurately predict postoperative outcomes is of considerable interest in the field of orthopaedic surgery. Machine learning has been used as a form of predictive modeling in multiple health-care settings. The purpose of the current study was to determine whether machine learning algorithms using preoperative data can predict improvement in American Shoulder and Elbow Surgeons (ASES) scores for patients with glenohumeral osteoarthritis (OA) at a minimum of 2 years after shoulder arthroplasty. METHODS This was a retrospective cohort study that included 472 patients (472 shoulders) diagnosed with primary glenohumeral OA (mean age, 68 years; 56% male) treated with shoulder arthroplasty (431 anatomic total shoulder arthroplasty and 41 reverse total shoulder arthroplasty). Preoperative computed tomography (CT) scans were used to classify patients on the basis of glenoid and rotator cuff morphology. Preoperative and final postoperative ASES scores were used to assess the level of improvement. Patients were separated into 3 improvement ranges of approximately equal size. Machine learning methods that related patterns of these variables to outcome ranges were employed. Three modeling approaches were compared: a model with the use of all baseline variables (Model 1), a model omitting morphological variables (Model 2), and a model omitting ASES variables (Model 3). RESULTS Improvement ranges of ≤28 points (class A), 29 to 55 points (class B), and >55 points (class C) were established. Using all follow-up time intervals, Model 1 gave the most accurate predictions, with probability values of 0.94, 0.95, and 0.94 for classes A, B, and C, respectively. This was followed by Model 2 (0.93, 0.80, and 0.73) and Model 3 (0.77, 0.72, and 0.71). CONCLUSIONS Machine learning can accurately predict the level of improvement after shoulder arthroplasty for glenohumeral OA. This may allow physicians to improve patient satisfaction by better managing expectations. These predictions were most accurate when latent variables were combined with morphological variables, suggesting that both patients' perceptions and structural pathology are critical to optimizing outcomes in shoulder arthroplasty. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul B. McLendon
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
| | - Kaitlyn N. Christmas
- Translational Research, Foundation for Orthopaedic Research and Education (F.O.R.E.), Tampa, Florida
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education (F.O.R.E.), Tampa, Florida
| | | | - Audrey Hunt
- Universal Research Solutions, LLC, Columbia, Missouri
| | - Adil S. Ahmed
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Mark A. Mighell
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
| | - Mark A. Frankle
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
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Puzzitiello RN, Nwachukwu BU, Agarwalla A, Cvetanovich GL, Chahla J, Romeo AA, Verma NN, Forsythe B. Patient Satisfaction After Total Shoulder Arthroplasty. Orthopedics 2020; 43:e492-e497. [PMID: 32818282 DOI: 10.3928/01477447-20200812-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/12/2019] [Indexed: 02/05/2023]
Abstract
Although patient-reported outcome measures use objective evaluations of impairment to focus on subjective responses, these measures may not necessarily reflect patient satisfaction with the outcome or the care provided. The goal of this study was to systematically review the available literature to assess patient satisfaction after total shoulder arthroplasty. Two investigators systematically reviewed the MEDLINE database for articles on satisfaction after this procedure. This study included 47 articles. The most commonly used method for assessing satisfaction was an ordinal scale (27 studies, 57.4%). Of the studies, 27 (57.5%) differentiated between patient satisfaction with the care provided and with the outcome achieved. Reported satisfaction rates after anatomic total shoulder arthroplasty ranged from 75% to 100%. For the included studies, increasing age, workers' compensation status, depression, opioid use, and visual analog scale pain score were the only preoperative factors that were significantly associated with worse postoperative satisfaction. Postoperative American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Subjective Shoulder Value score, Short Form-36 mental component score, range of motion, visual analog scale pain score, and ability to perform activities of daily living showed a significant association with postoperative satisfaction. Studies of satisfaction after total shoulder arthroplasty are of low evidence levels. Although overall patient satisfaction is high, there is no standardized method for measuring satisfaction. For the identified studies, the most common assessment method was an ordinal scale that consists of qualitative values representing increasing levels of satisfaction. Orthopedic surgeons are increasingly expected to demonstrate the value of procedures, and a uniform and validated method of assessing patient satisfaction is needed. [Orthopedics. 2020;43(6):e492-e497.].
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Kennedy JS, Garrigues GE, Pozzi F, Zens MJ, Gaunt B, Phillips B, Bakshi A, Tate AR. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2149-2162. [PMID: 32534209 PMCID: PMC8262512 DOI: 10.1016/j.jse.2020.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health Systems, Durham, NC, USA.
| | | | | | | | - Bryce Gaunt
- Human Performance Rehabilitation Centers at St Francis Rehabilitation Center, Columbus, GA, USA
| | - Brian Phillips
- Human Performance Rehabilitation Centers at St Francis Rehabilitation Center, Columbus, GA, USA
| | - Ashim Bakshi
- The Hand and Orthopedic Rehab Clinic, Terre Haute, IN, USA
| | - Angela R Tate
- Excel Physical Therapy, Blue Bell, PA, USA; Arcadia University, Glenside, PA, USA
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Henry LE, Aneizi A, Nadarajah V, Sajak PMJ, Stevens KN, Zhan M, Gilotra MN, Packer JD, Henn RF. Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S829-S836. [PMID: 32999564 PMCID: PMC7503149 DOI: 10.1016/j.jcot.2020.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preoperative patient expectations and met expectations are likely associated with the outcome of treatment. However, there is a lack of data regarding the preoperative expectations and early postoperative met expectations of patients undergoing extremity orthopaedic surgery. The purpose of this study was to identify the predictors of early postoperative met expectations in a cohort of patients undergoing extremity orthopaedic surgery and to assess the relationship between patient expectations and patient-reported outcome (PRO) measures. We hypothesized that patients with higher preoperative expectation scores and higher postoperative met expectation scores would have better early postoperative outcomes. METHODS Four hundred thirty-five patients age seventeen and older who underwent extremity orthopaedic surgery at one institution were prospectively enrolled in this study. Each patient completed a preoperative questionnaire that included an assessment of demographics, pain, function, general health, treatment expectations, activity level, and Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive testing. Expectations were evaluated using the Expectations Domain of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire. Patients completed a follow-up questionnaire two weeks after surgery that also assessed MODEMS met expectations and satisfaction (Surgical Satisfaction Questionnaire (SSQ-8)). RESULTS The mean preoperative expectation score was 86.95 ± 16.59, and the mean postoperative met expectation score was 55.02 ± 27.63 (0-100 scale with 100 representing the highest level of expectations). Greater met expectations were significantly associated with white race (p = 0.025), college degree (p = 0.011), and higher income (p = 0.002). Greater met expectations were also significantly associated with greater postoperative physical function, social satisfaction, activity level, and subjective improvement, as well as lower pain interference, joint pain, body pain, fatigue, anxiety, and depression (p < 0.01 for each). Multivariable analysis results found that less postoperative joint pain and greater postoperative social satisfaction, improvement, and physical function were all significant independent predictors of greater met expectations at two weeks postoperative (p < 0.01 for each). CONCLUSION Greater preoperative expectations are associated with better activity and less pain two weeks after surgery. Met expectations of extremity orthopaedic surgery were associated with postoperative physical function, social satisfaction, activity, pain, anxiety, depression, and subjective improvement. These results may have implications for preoperative counseling and risk factor modification.
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Affiliation(s)
- Leah E. Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick MJ. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kali N. Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. University of Maryland School of Medicine, Department of Orthopaedics, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Nadarajah V, Stevens KN, Henry L, Jauregui JJ, Smuda MP, Ventimiglia DJ, Gilotra MN, Hasan SA, Henn RF. Patients undergoing shoulder surgery have high preoperative expectations. Knee Surg Sports Traumatol Arthrosc 2020; 28:2377-2385. [PMID: 31912166 DOI: 10.1007/s00167-019-05824-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery. METHODS Data from a total of 319 patients (319 shoulders) from 2015-2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations. RESULTS The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score. CONCLUSION The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leah Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. .,University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Psychosocial factors affecting outcomes after shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2020; 29:e175-e184. [PMID: 31899094 DOI: 10.1016/j.jse.2019.09.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both anatomic and reverse total shoulder arthroplasty are considered successful surgeries to treat a variety of painful shoulder conditions. Although implant survivorship for both is good to excellent in the long term, a variety of factors-clinical, technical, and psychosocial-may affect patient-reported outcomes after shoulder arthroplasty. METHODS A comprehensive review of the literature was performed systematically using keywords "shoulder arthroplasty outcomes," "psychosocial factors shoulder," "shoulder replacement outcomes," "depression shoulder arthroplasty," "satisfaction shoulder arthroplasty," "factors shoulder replacement," "expectations shoulder arthroplasty," and "predictors shoulder arthroplasty." Studies meeting the inclusion criteria were screened and analyzed. Type of surgery performed, sample size, outcome measures, and other factors influencing patient outcomes were recorded and analyzed. RESULTS Sixteen studies met the inclusion criteria. Six reviewed mental health disorders as predictors of postoperative outcome after shoulder arthroplasty. Of these, 4 found that disorders such a depression and anxiety were associated with increased risk of perioperative complications and lower final functional outcome scores. Two studies evaluated workers' compensation status as a possible predictor of outcomes and found that patients with claims had lower satisfaction and outcome scores at final follow-up compared with those without claims. Two studies showed that preoperative opioid use was associated with lower outcome scores and overall satisfaction rate after shoulder arthroplasty. Three studies showed that higher patient confidence and preoperative expectations were correlated with better outcomes. CONCLUSION Our review shows that psychosocial factors may play just as important role in affecting patient outcomes after total shoulder arthroplasty as technical factors.
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Sajak PMJ, Aneizi A, Gopinath R, Nadarajah V, Burt C, Ventimiglia D, Akabudike N, Zhan M, Henn RF. Factors associated with early postoperative survey completion in orthopaedic surgery patients. J Clin Orthop Trauma 2020; 11:S158-S163. [PMID: 31992938 PMCID: PMC6978185 DOI: 10.1016/j.jcot.2019.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/20/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine factors associated with survey compliance 2-weeks postoperatively. METHODS 1269 patients age 17-years and older participating in the Maryland Orthopaedic Registry from August 2015-March 2018 were administered a baseline questionnaire preoperatively and emailed a follow-up questionnaire 10-days postoperatively. Demographics were self-reported and medical records reviewed for relevant medical history. RESULTS 609 patients (48.0%) completed both the baseline and 2-week surveys. A decreased likelihood of 2-week survey completion was seen in patients who identified as black, smokers, patients without a college education, patients who were unmarried, unemployed, had a lower income, or covered by government-sponsored insurance (p < 0.05). Other preoperative variables significantly associated with decreased likelihood of completion included surgery on the right side, upper extremity surgery, preoperative opioid use, no specific injury leading to surgery, lower preoperative expectations, depression and fatigue symptoms, and worse pain, function, and activity scores (p < 0.05). Multivariable analysis confirmed race, operative extremity, education, insurance status, smoking, activity level, and pain scores were independent predictors of survey completion. CONCLUSION Several demographic and preoperative variables are associated with survey completion 2-weeks post-orthopaedic surgery. The results provide insight into patient populations that may be targeted in order to assure higher survey compliance and improve analysis of patient-reported outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R. Frank Henn
- Corresponding author. Department of Orthopaedics University of Maryland Rehabilitation and Orthopaedic Institute 2200 Kernan Drive Baltimore, MD, 21207, USA.
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Garcia GH, Gowd AK, Liu JN, Malaret MR, Cabarcas BC, Romeo AA. Return to Sport Following Hemiarthroplasty With Concentric Reaming Versus Total Shoulder Arthroplasty: A Matched Pair Analysis. Orthopedics 2019; 42:276-284. [PMID: 31269217 DOI: 10.3928/01477447-20190627-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to establish functional outcomes regarding return to sport activity for patients receiving anatomical total shoulder arthroplasty (aTSA) vs the ream and run procedure (hemi RR). Patients who underwent hemi RR and who underwent aTSA with a polyethylene glenoid component for end-stage glenohumeral arthritis were retrospectively identified from 2000 to 2014. Patients were matched regarding age, body mass index, sex, and hand dominance. Patients were surveyed to determine their level of sport and satisfaction after surgery. At a mean follow-up of 69.1±24.8 months, a total of 26 hemi RR and 30 aTSA patients met inclusion/exclusion criteria. Mean±SD age at the time of surgery was 53.0±8.5 years. There was no statistical difference between the two cohorts regarding patients who reported no postoperative problems (69.2% vs 76.7%, P=.529), reoperation (11.5% vs 6.7%, P=.522), return to overall sport (94.4% vs 86.4%, P=.395), return to high-demand upper-extremity sport (92.3% vs 81.3%, P=.390), and return to same or better level of intensity sport (83.3% vs 72.7%, P=.424). Patients returned to sport at a mean of 7.5±5.7 months and 6.2±3.6 months in the hemi RR and aTSA cohorts, respectively (P=.485). Radiographic measurements of medialization (mean, -2.4±5.0 vs -2.2±5.7; P=.913) and postoperative decentering (mean, 3.6%±2.6% vs 4.3%±3.3%; P=.795) were equivalent for the two cohorts. Hemi RR was found to have high and equivalent rates of sporting outcomes, clinical outcomes, and radiographic outcomes compared with aTSA. As appropriately indicated patients are counseled for surgery, realistic expectations regarding sports should be discussed. [Orthopedics. 2019; 42(5):276-284.].
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Rauck RC, Swarup I, Chang B, Ruzbarsky JJ, Dines DM, Warren RF, Henn RF, Gulotta LV. Preoperative patient expectations of elective reverse shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1217-1222. [PMID: 30904239 DOI: 10.1016/j.jse.2018.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine patients' preoperative expectations before primary elective reverse shoulder arthroplasty (RSA). We hypothesized that younger patients, patients with better preoperative function, patients with shoulder osteoarthritis (OA), and patients with no prior joint replacements would have higher expectations of RSA. METHODS We prospectively studied 333 primary RSAs performed for cuff tear arthropathy (n = 242), OA (n = 68), or post-traumatic arthritis (n = 23). Expectations were assessed preoperatively using the Hospital for Special Surgery's shoulder surgery expectations survey. Preoperative patient-reported measures were assessed with the American Shoulder and Elbow Surgeons shoulder score; Shoulder Activity Scale score; Short Form 12 mental component and physical component scores; and visual analog scale scores for pain, fatigue, and general health. A Poisson regression model was performed to control for potential confounding variables. RESULTS Relief of night-time pain, relief of daytime pain, improvement in self-care, improvement in the ability to drive or put on a seat belt, and improvement in the ability to perform daily activities were reported as "very important" by approximately half of patients. No association was found between age and overall expectations. Multivariate analysis showed that better preoperative Shoulder Activity Scale and Short Form 12 physical component scores were associated with greater expectations (P < .001). OA was associated with greater expectations compared with cuff tear arthropathy (P < .001). A history of either contralateral RSA or any joint replacement was associated with lower expectations (P < .001). CONCLUSION Patients have the highest expectations for pain relief and the performance of simple tasks after RSA. Patients with higher preoperative function, OA, and no previous joint replacements have greater expectations of RSA.
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Affiliation(s)
- Ryan C Rauck
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
| | - Ishaan Swarup
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Brenda Chang
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Joseph J Ruzbarsky
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lawrence V Gulotta
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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A Systematic Review of Proposed Rehabilitation Guidelines Following Anatomic and Reverse Shoulder Arthroplasty. J Orthop Sports Phys Ther 2019; 49:337-346. [PMID: 31021690 DOI: 10.2519/jospt.2019.8616] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Reverse total shoulder arthroplasty (RTSA) is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. In this procedure, a glenosphere articulates with a humerosocket. While those surgeries are commonly performed, a thorough review of the literature is required to determine the areas of agreement and variations in postoperative rehabilitation. OBJECTIVES To describe the literature on rehabilitation protocols following anatomic TSA and RTSA. METHODS For this systematic review, a computerized search was conducted in medical databases from inception to May 21, 2018 for relevant descriptive studies on TSA and RTSA rehabilitation protocols. The methodological index for nonrandomized studies tool and the modified Downs and Black tool for randomized controlled trials were used for assessment of the individual studies. RESULTS Sixteen studies met the inclusion criteria, of which 1 provided level I evidence, 1 provided level III evidence, 2 provided level IV evidence, and 12 provided level V evidence. Ten of the studies described rehabilitation guidelines for TSA and 6 described those for RTSA. Following TSA, the use of a sling was recommended for a duration that varied from 3 to 8 weeks, and 4 of the 10 published protocols included resisted exercise during the initial stage of healing (the first 6 weeks after surgery). Seven of 10 published protocols recommended limiting shoulder external rotation to 30° and that passive range of motion be fully restored by 12 weeks post surgery. Suggested use of a sling post RTSA varied from "for comfort only" to 6 weeks, motion parameters varied from no passive range of motion to precautionary range limits, and all protocols agreed on performing deltoid isometric exercises early post surgery. There was a high level of heterogeneity for the rehabilitation guidelines and associated precautions for both TSA and RTSA. CONCLUSION The majority of published protocols were descriptive in nature. Published rehabilitation strategies following TSA and RTSA are based on biomechanical principles, healing time frames, and exercise loading principles, with little consistency among protocols. There is a need to determine optimal rehabilitation approaches post TSA and RTSA based on clinical outcomes. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2019;49(5):337-346. doi:10.2519/jospt.2019.8616.
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Webster KE, Feller JA. Expectations for Return to Preinjury Sport Before and After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:578-583. [PMID: 30649903 DOI: 10.1177/0363546518819454] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited information about patient expectations regarding return to sport after anterior cruciate ligament reconstruction (ACLR). While it has generally been assumed that patients expect to return, it has also been acknowledged that expectations may change after surgery. PURPOSE To investigate return-to-sport expectations before and after ACLR and determine factors associated with changed expectations. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study sample consisted of 675 eligible patients (437 male, 238 female). Return-to-sport expectations were recorded preoperatively. Primary ACLR was performed in 595 patients (of whom 81 had a prior contralateral ACLR) and revision ACLR in 80 patients. At 12 months after surgery, the return to preinjury sport status was assessed along with patients' current sport expectations. The proportion of patients who expected to return to their preinjury level of sport was determined along with actual return rates. Logistic regression was performed to determine the factors associated with the decision to cease sport participation in patients who had expected to be able to return to their preinjury level of sport. RESULTS Overall, 84% of patients expected to be able to return to their preinjury level of sport. Expectations were higher for patients about to undergo their first ACLR, with 88% expecting to return, than for those about to undergo revision surgery or second primary ACLR (63% and 80% expected to return, respectively; P < .001 and P = .08, respectively). At 12 months after surgery, 24% of patients who expected to return to their preinjury level of sport had actually returned, and 15% of all patients had already decided to give up sport. In the regression models, being female ( P = .02) and having undergone previous ACLR ( P < .0001) were factors significantly associated with the decision to give up sport participation. CONCLUSION Patients had high expectations for returning to their preinjury level of sport at the time of undergoing initial ACLR. Expectations were lower for those who had undergone previous ACLR. Female patients and patients who had undergone previous ACLR were more likely to change their expectations and cease sport participation. These data can be used to provide patients with realistic return-to-sport expectations in the first postoperative year and highlight the challenge for patients who aim to return from multiple ACL injuries.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
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Swarup I, Henn CM, Gulotta LV, Henn RF. Patient expectations and satisfaction in orthopaedic surgery: A review of the literature. J Clin Orthop Trauma 2019; 10:755-760. [PMID: 31316250 PMCID: PMC6611830 DOI: 10.1016/j.jcot.2018.08.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
Patient expectations have been shown to be an independent predictor of outcomes in clinical medicine. In the orthopaedic literature, the majority of studies have focused on the relationship between pre-operative expectations and post-operative outcomes in patients undergoing total hip arthroplasty, total knee arthroplasty, shoulder surgery, and spine surgery. Various methodologies have been used to assess patient expectations in orthopaedic surgery, including direct questioning, short questionnaires, and validated surveys. Multiple patient factors have been associated with greater expectations prior to elective orthopaedic surgery, and greater pre-operative expectations have been shown to be associated with better subjective and objective outcomes after total hip and knee arthroplasty, shoulder surgery, and spine surgery. While there are very few validated measures of patient satisfaction after orthopaedic surgery, increased post-operative patient satisfaction is consistently associated with meeting pre-operative patient expectations. Given the relationship between pre-operative patient expectations and post-operative outcomes and patient satisfaction, understanding and defining expectations prior to elective orthopaedic surgery may optimize outcomes. In this review, we aim to summarize the current literature on patient expectations in orthopaedic surgery.
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Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
- Corresponding author.
| | - Curtis M. Henn
- Department of Orthopaedic Surgery, Medstar Georgetown Orthopaedic Institute, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Lawrence V. Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207, USA
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Rauck RC, Swarup I, Chang B, Dines DM, Warren RF, Gulotta LV, Henn RF. Effect of preoperative patient expectations on outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:e323-e329. [PMID: 30343687 DOI: 10.1016/j.jse.2018.05.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the effect of preoperative expectations on outcomes after reverse shoulder arthroplasty (RSA). We hypothesized that patients with greater expectations would have better outcomes. METHODS Patients undergoing primary RSA completed the Hospital for Special Surgery's Shoulder Expectations Survey preoperatively. Preoperative and 2-year postoperative clinical outcomes were measured with the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Shoulder Activity Scale (SAS), 36-Item Short Form Health Survey (SF-36), and visual analog scales (VASs). Pearson correlations were used to assess the relationship between the number of expectations and outcomes. Differences in outcomes between those with higher and lower levels of expectations for each expectation question were assessed by independent samples t test. Multivariable linear regression analysis was used to control for potential confounding factors. RESULTS We evaluated 135 patients at 2 years postoperatively. Patients had higher expectations for relieving pain, improving self-care, improving ability to perform daily activities, and improving ability to drive or put on a seatbelt. Patients with a greater number of high expectations preoperatively did not have better ASES, SAS, or VAS pain scores postoperatively. However, higher expectations for relieving nighttime pain was associated with ASES (β = 7.0, P = .048) and VAS pain scores (β = -5.9, P = .047) as well as 2-year improvement of VAS pain (β = -6.1, P = .039). Higher expectations for improving the ability to participate in nonoverhead sports was associated with improvements in SAS (β = 2.8, P = .020). CONCLUSION A higher level of expectations for relief of nighttime pain and improving ability to participate in nonoverhead sports is associated with improved outcomes after RSA.
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Affiliation(s)
- Ryan C Rauck
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.
| | - Ishaan Swarup
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Brenda Chang
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Koenig S, Nadarajah V, Smuda MP, Meredith S, Packer JD, Henn RF. Patients' Use and Perception of Internet-Based Orthopaedic Sports Medicine Resources. Orthop J Sports Med 2018; 6:2325967118796469. [PMID: 30263896 PMCID: PMC6149032 DOI: 10.1177/2325967118796469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Current research is sparse regarding how patients with orthopaedic injuries
perceive and use internet-based information resources. Hypothesis: The majority of patients use the internet to research their orthopaedic
condition and are receptive to guidance from their provider. Study Design: Cross-sectional study. Methods: A total of 213 patients attending a sports medicine clinic on the East Coast
of the United States were asked to complete a questionnaire regarding their
use of internet-based information. Data from 185 patients were available for
analysis. Bivariate and multivariate statistical analyses were used to
determine the significance of identified associations. Results: Overall, 54% of patients used the internet to find information about their
orthopaedic condition prior to their consultation. A higher percentage of
internet users were women (P = .01), were white
(P = .03), and had internet access at home
(P = .02). Multivariable analysis found home internet
access to be the only significant independent factor predictive of patients
using internet-based information sources (P < .01). The
majority of patients (61%) were neutral toward orthopaedic information found
online, and only 32% of patients trusted the orthopaedic information they
found online. The majority of patients (83%) reported they would be
receptive to providers’ guidance on which internet resources to use. Conclusion: Only half of patients use the internet to research their orthopaedic
condition. Most patients were either neutral toward or did not trust the
internet-based information that they found and may forgo internet sources
altogether. To help patients avoid misleading information, sports medicine
providers should understand how patients are using the internet and guide
patients in selecting high-quality, peer-reviewed sources of information.
Doing so allows physicians to proactively educate their patients even after
the clinic visit.
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Affiliation(s)
- Scott Koenig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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The "tipping point" for 931 elective shoulder arthroplasties. J Shoulder Elbow Surg 2018; 27:1614-1621. [PMID: 29748122 DOI: 10.1016/j.jse.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND A patient with arthritis usually experiences the progression of symptoms over time. At some stage, the patient may decide that the symptoms have reached a level of severity that leads him or her to elect to proceed with joint replacement; we refer to this degree of symptom severity as the "tipping point." Our goal was to study the factors that influenced the tipping point for patients undergoing elective shoulder arthroplasty. METHODS We analyzed the characteristics of 931 patients undergoing shoulder arthroplasty to determine the factors affecting the tipping point as characterized by the patients' comfort and function at the time they determined their symptoms had progressed to the point when this elective surgery was merited. RESULTS The preoperative Simple Shoulder Test (SST) score for all patients averaged 3.6 ± 2.7. The average tipping points were different for the ream-and-run procedure (mean SST score, 5.0 ± 2.5), hemiarthroplasty (mean SST score, 3.1 ± 3.3), total shoulder arthroplasty (mean SST score, 3.0 ± 2.4), cuff tear arthropathy arthroplasty (mean SST score, 2.8 ± 2.5), and reverse total shoulder arthroplasty (mean SST score, 1.5 ± 1.8). A number of other factors were significantly associated with a higher tipping point: younger age, better health, male sex, commercial insurance, married, nonuse of narcotics, use of alcohol, and shoulder problem not related to work. CONCLUSIONS Analysis of the tipping point-the patients' self-assessed comfort and function at the point they decide to undergo shoulder joint replacement-provides a means by which surgeons can understand the factors influencing the indications for these procedures.
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Carrier CS, Garvey KD, Brook EM, Matzkin EG. Patient Satisfaction With Nonopioid Pain Management Following Knee Arthroscopic Partial Meniscectomy and/or Chondroplasty. Orthopedics 2018; 41:209-214. [PMID: 29913027 DOI: 10.3928/01477447-20180613-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the efficacy of nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty and to assess patients' attitudes regarding their need for opioid pain medication following these procedures. Patients who underwent a knee arthroscopy procedure for either partial meniscectomy and/or chondroplasty from July 2016 to January 2017 by a single surgeon at a single institution were included. Medical records were reviewed, and demographics were recorded. Two weeks postoperatively, patients self-reported opioid and nonopioid medication use. Patients were also questioned regarding their perceived need for opioid medication, whether they felt their pain was adequately controlled, and how their pain compared with their preoperative expectations. Thirty-four patients (17 male, 17 female), with a mean age at the time of surgery of 47.79 years (range, 19-68 years), were included. Eighty-two percent (n=28) of the patients reported using nonopioid analgesics for pain control, whereas 18% (n=6) reported using opioids. Of those not using opioids, 96.4% (n=27) reported not feeling the need for opioid medications. Three of 6 patients requiring opioids were unable to take nonsteroidal anti-inflammatory drugs. All 6 patients who took opioids felt that they needed them for adequate pain control. This study provides initial encouragement that it is largely possible to remove opioids from the postoperative pain regimen of knee arthroscopy patients and maintain adequate pain control and patient satisfaction. [Orthopedics. 2018; 41(4):209-214.].
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Gauci MO, Bonnevialle N, Moineau G, Baba M, Walch G, Boileau P. Anatomical total shoulder arthroplasty in young patients with osteoarthritis: all-polyethylene versus metal-backed glenoid. Bone Joint J 2018; 100-B:485-492. [PMID: 29629579 DOI: 10.1302/0301-620x.100b4.bjj-2017-0495.r2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components. Materials and Methods A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan-Meier survivorship analysis was performed with revision as the endpoint. Results A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years' follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene components and 24% (sd 0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component. Conclusion The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure. Cite this article: Bone Joint J 2018;100-B:485-92.
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Affiliation(s)
- M O Gauci
- Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2 and Université Nice-Sophia Antipolis, Nice Cedex 1, France
| | - N Bonnevialle
- Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - G Moineau
- Clinique Pasteur-Lanroze, Brest, France
| | - M Baba
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - G Walch
- Centre Médical Santy, Lyon, France
| | - P Boileau
- Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2 and Université Nice-Sophia Antipolis, Nice Cedex 1, France
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Kadum B, Inngul C, Ihrman R, Sjödén GO, Sayed-Noor AS. Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty. Bone Joint J 2018; 100-B:480-484. [DOI: 10.1302/0301-620x.100b4.bjj-2017-1000.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty (TSA). Patients and Methods In this prospective study, we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively. There were 31 women and 32 men; their mean age was 71 years (53 to 89). The pain threshold, which was measured using a Pain Matcher (PM) unit, the degree of pain (visual analogue scale at rest and on exertion, and function using the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded preoperatively, as well as three and 12 months postoperatively. Results We found an inverse relationship between both the preoperative PM threshold and pain (VAS) at rest and the 12-month postoperative QuickDASH score (Pearson correlation coefficient (r) ≥ 0.4, p < 0.05). A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain (VAS) at rest were the only factors associated with the QuickDASH score at 12 months. Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA. Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients. Cite this article: Bone Joint J 2018;100-B:480–4.
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Affiliation(s)
- B. Kadum
- Department of Clinical and Experimental
Medicine and Department of Orthopaedics,, Ryhov
Hospital, Linköping University, Jonkoping, Sweden
| | - C. Inngul
- Department of Clinical Science and Education,
Section of Orthopaedics, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - R. Ihrman
- Department of Orthopaedics,, Ryhov
Hospital, Linköping University, Jönköping, Sweden
| | - G. O. Sjödén
- Department of Surgical and Perioperative
Sciences and Department of Orthopaedics, Umeå
University, Södersjukhuset, Stockholm, Sweden
| | - A. S. Sayed-Noor
- Department of Surgical and Perioperative
Sciences,, Umeå University, Södersjukhuset, Stockholm, Sweden
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Raiss P, Alami G, Bruckner T, Magosch P, Habermeyer P, Boileau P, Walch G. Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal humerus. Bone Joint J 2018; 100-B:318-323. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0947.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder. Patients and Methods A total of 38 patients were included: 28 women and ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91). Before the RSA, 18 patients had been treated with open reduction and internal fixation following a fracture. A total of 22 patients had a rotator cuff tear and 11 had severe stiffness of the shoulder with < 0° of external rotation. The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of movement of the shoulder were recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as well as CT or arthro-CT scans; radiographs were also performed at final follow-up. Results The mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points (15 to 81) postoperatively. The mean forward elevation of the shoulder increased from 73° (10° to 130°) preoperatively to 117° (15° to 170°) postoperatively. Previous surgery did not influence the outcome. Patients with rotator cuff tears had lower Constant scores than patients without (p = 0.037). Those with preoperative stiffness of the shoulder had lower postoperative external rotation compared with patients without stiffness (p = 0.046). There was no radiographic evidence of loosening. Three complications occurred, leading to revision surgery in two patients. In all, 17 patients rated their result as very good (45%), another 17 as good (45%), two as satisfactory (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318–23.
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Affiliation(s)
- P. Raiss
- OCM (Orthopädische Chirurgie München)
Clinic, Steinerstrasse 6, 81369
München, Germany
| | - G. Alami
- Chirurgie Orthopédique, Hôpital St-Jérôme, 290
Rue de Montigny, Saint-Jérome, St-Jérôme, Québec
J7Z-5T3, Canada
| | - T. Bruckner
- University of Heidelberg, Institute of
Medical Biometry and Informatics, Im Neuenheimer
Feld 305, 69120 Heidelberg, Germany
| | - P. Magosch
- ATOS Clinic Heidelberg, Bismarckstrasse
9-15, 69115 Heidelberg, Germany
| | - P. Habermeyer
- ATOS Clinic Heidelberg, Bismarckstrasse
9-15, 69115 Heidelberg, Germany
| | - P. Boileau
- Hôpital Pasteur 2, 30, Avenue
de la Voie Romaine, 06001 Nice, France
| | - G. Walch
- Centre Orthopédique Santy, 24, Avenue
Paul Santy, 69008 Lyon, France
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Affiliation(s)
- F. S. Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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