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Muthu S, Vadranapu S. Variations in quantifying patient reported outcome measures to estimate treatment effect. World J Methodol 2025; 15:97078. [DOI: 10.5662/wjm.v15.i2.97078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 10/13/2024] [Accepted: 11/06/2024] [Indexed: 11/27/2024] Open
Abstract
In the practice of healthcare, patient-reported outcomes (PROs) and PRO measures (PROMs) are used as an attempt to observe the changes in complex clinical situations. They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect. For any PROM to be usable in health care, we need it to be reliable, encapsulating the points of interest with the potential to detect any real change. Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview, and this allows the physician and patient to have a meaningful conversation as well as a customized plan for each patient. Having mentioned the rationale and the benefits of PROMs, understanding the quantification process is crucial before embarking on management decisions. A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition. There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences. This article details the various quantification metrics used to evaluate the treatment effect using PROMs, their limitations and the scope of usage and implementation in clinical practice.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
- Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
| | - Srujun Vadranapu
- Department of Orthopaedics, Royal Care Super Speciality Hospital, Coimbatore 641062, Tamil Nadu, India
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Le Roux J, Janse van Rensburg DC, Kemp S, Lambert M, Readhead C, Stokes K, Viljoen W, Kerkhoffs G, Gouttebarge V. Shoulder and knee surgery double odds of osteoarthritis in retired professional rugby players. J Sci Med Sport 2025:S1440-2440(25)00096-9. [PMID: 40254506 DOI: 10.1016/j.jsams.2025.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 03/10/2025] [Accepted: 03/29/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVES This study i) described the prevalence of clinically diagnosed shoulder and knee osteoarthritis among retired male professional rugby players, ii) determined the association of severe injury and related surgery with shoulder and knee osteoarthritis, and iii) described players' level of shoulder and knee function and compared it to matched controls. DESIGN Observational study with a cross-sectional design using questionnaires. METHODS Retired professional rugby players and matched controls from a non-elite sporting background were recruited. Single questions and validated questionnaires determined clinical shoulder and knee osteoarthritis as well as shoulder and knee function. Logistic regression analysis was conducted to examine potential associations, whilst comparisons with matched controls for shoulder and knee function were explored using the Mann-Whitney test for independent samples. RESULTS Fourteen percent of the retired male professional rugby players (n = 146; mean age = 39.6 years) had clinical shoulder osteoarthritis and 23 % had clinical knee osteoarthritis. Every shoulder surgery doubled retired rugby players' odds of having clinical shoulder osteoarthritis (odds ratio = 2.1; 95 % confidence interval = 1.1-3.9) and every knee surgery doubled retired rugby players' odds of having clinical knee osteoarthritis (odds ratio = 2.0; 95 % confidence interval = 1.2-3.3). CONCLUSIONS Clinical shoulder and knee osteoarthritis is a common medical condition among retired professional rugby players. Long-term consequences should be considered when managing shoulder and knee injuries during professional rugby players' careers.
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Affiliation(s)
- Johan Le Roux
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, the Netherlands. https://twitter.com/johanleroux13
| | - Dina C Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, South Africa. https://twitter.com/ChristaJVR
| | - Simon Kemp
- Rugby Football Union, UK; London School of Hygiene and Tropical Medicine, UK
| | - Mike Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, South Africa; Human Kinetics and Ergonomics, Rhodes University, South Africa
| | - Clint Readhead
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, South Africa; South African Rugby Union (SARU), South Africa
| | - Keith Stokes
- Rugby Football Union, UK; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), IOC Research Centre of Excellence, University of Bath, UK
| | - Wayne Viljoen
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, South Africa; South African Rugby Union (SARU), South Africa
| | - Gino Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, the Netherlands; Academic Center for Evidence-based Sports Medicine (ACES), the Netherlands; Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, the Netherlands; Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, the Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, the Netherlands; Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Academic Center for Evidence-based Sports Medicine (ACES), the Netherlands; Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, the Netherlands; Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, the Netherlands.
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De Santis A, Brindisino F, Ardini V, Venturin D, Ugolini A, Pellicciari L, Corradini A, Ceccaroli A, Griffin S, Longo UG. Cross-cultural adaptation, reliability, and validity of the Italian version of the Western Ontario Rotator Cuff (WORC) Index in subjects with rotator cuff diseases. Musculoskelet Sci Pract 2025; 76:103276. [PMID: 39955999 DOI: 10.1016/j.msksp.2025.103276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/29/2025] [Accepted: 01/31/2025] [Indexed: 02/18/2025]
Abstract
PURPOSE The Western Ontario Rotator Cuff (WORC) Index is a disease-specific, recommended tool to investigate the quality of life in subjects with rotator cuff (RC) disorders and tears. The purpose of this study was to deeply assess the psychometric properties of the WORC Index in patients with RC disorders and repair. METHODS The WORC Index was translated and cross-culturally adapted into Italian according to international guidelines and administered to 149 subjects with RC disorders or repair. Subjects completed the WORC Index, the American Shoulder and Elbow Surgeon Standardized Shoulder Assessment Form (ASES), the Short-Form Health Survey 36 (SF-36), and the Numerical Pain Rating Scale (NPRS). Confirmatory Factor Analysis (CFA) was run to investigate the structural validity. Internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation coefficient [ICC]), measurement error (Standard Error of Measurement [SEM], Minimum Detectable Change [MDC95]), and construct validity (a-priori hypothesis testing with the correlation with the other outcome measures) were also assessed. RESULTS After addressing local item dependency, the final CFA confirmed a five-subscale structure (RMSEA = 0.059; SRMSR = 0.04; CFI = 0.969; TLI = 0.958). Cronbach's alpha ranged from 0.843 to 0.933. The test-retest reliability was excellent (ICC ranged from 0.873 to 0.929). SEM ranged from 6.1 to 9.9 points, and MCD95 varied from 17 to 27.4 points. Construct validity was considered satisfactory for all subscales. CONCLUSION The Italian version of the WORC Index demonstrated validity and reliability in assessing subjects with RC disorders and repair. It is recommended for use in clinical practice and research.
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Affiliation(s)
- Andrea De Santis
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy; Physiotherapy Private Practice Physiofit, Latina, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | | | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy; Physiotherapy Private Practice Kinè, San Vendemiano, Italy; Kinè s.r.l, Treviso, Italy
| | | | | | | | - Alice Ceccaroli
- Fondazione Politecnico Universitario Campus Bio-Medico, Rome, Italy
| | - Sharon Griffin
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, ON, Canada
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Larsen JB, Thillemann TM, Launonen AP, Østergaard HK, Falstie-Jensen T, Sumrein B, Zivanovic S, Jensen SL, Mechlenburg I, Ponkilainen V. Minimal important change of the Western Ontario Osteoarthritis of the Shoulder (WOOS) index in patients with glenohumeral osteoarthritis and rotator cuff tear arthropathy. Arch Orthop Trauma Surg 2025; 145:162. [PMID: 39954127 PMCID: PMC11829846 DOI: 10.1007/s00402-025-05778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/02/2025] [Indexed: 02/17/2025]
Abstract
INTRODUCTION The Minimal Important Change (MIC) for patient-reported outcome measures is the value that describes the smallest improvement considered worthwhile by patients. To the best of our knowledge, no MIC of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) score or the Disabilities of the Arm Shoulder and Hand (DASH) has been reported using the anchor-based predictive modeling approach based on patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy. The aim of this study was to determine the MIC for WOOS and DASH in a cohort of patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy treated with a total shoulder arthroplasty. MATERIALS AND METHODS Data on 231 patients were collected at four hospitals in Denmark and Finland. Data were collected at baseline and 12 weeks after surgery. At 12 weeks, the patients were asked about their perceived overall improvement after surgery measured by the Patient Global Impression of Change (PGI-C). The MIC was estimated for the WOOS and DASH using the adjusted predictive modeling approach with the PGI-C as an anchor. RESULTS Of the 231 included patients, 104 were included in the MIC analysis. Patients had a mean age of 71 years and 56% were women. The estimated adjusted MIC for the WOOS score was 13.3 (-6.2; 23.3) and 7.2 (12.8; 1.7) for DASH. CONCLUSION For patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy treated with a total shoulder arthroplasty, the estimated MIC for was 13.3 for WOOS and 7.2 for DASH. The estimates show wide confidence intervals, which could be due to the low sample size but could also indicate a large heterogeneity within the patient group.
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Affiliation(s)
- Josefine Beck Larsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark.
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark.
| | - Theis Muncholm Thillemann
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Antti P Launonen
- Department of Orthopaedic Surgery, Tampere University Hospital, Teiskontie 35, Tampere, FI-33520, Finland
| | | | - Thomas Falstie-Jensen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Bakir Sumrein
- Department of Orthopaedic Surgery, Tampere University Hospital, Teiskontie 35, Tampere, FI-33520, Finland
| | - Srdjan Zivanovic
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Heibergs Alle 4 F, Viborg, DK-8800, Denmark
| | - Steen Lund Jensen
- Department of Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup, Aalborg, DK-9260, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ville Ponkilainen
- Department of Orthopaedic Surgery, Tampere University Hospital, Teiskontie 35, Tampere, FI-33520, Finland
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Jensen ML, Valsamis EM, Madrid AS, Olsen BS, Rasmussen JV. Association between socioeconomic status and patient-reported outcome at 1 year after shoulder arthroplasty for osteoarthritis or cuff-tear arthropathy: a nationwide cohort study of 2,292 arthroplasties. Acta Orthop 2025; 96:45-51. [PMID: 39786208 PMCID: PMC11718085 DOI: 10.2340/17453674.2024.42700] [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: 06/26/2024] [Accepted: 12/03/2024] [Indexed: 01/12/2025] Open
Abstract
PURPOSE We aimed to evaluate the association between socioeconomic factors and patient-reported Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year after hemiarthroplasty, reverse, or anatomical total shoulder arthroplasty for osteoarthritis or cuff-tear arthropathy. METHODS Eligible patients were identified using linked national data from the Danish Shoulder Arthroplasty Registry and Statistics Denmark between April 2012 and April 2019. Univariable and multivariable linear regression was used to identify the association between socioeconomic factors and the WOOS index at 1 year following primary shoulder arthroplasty adjusted for age, sex, underlying diagnosis, implant design, and comorbidities. We examined socioeconomic factors including employment status, marital status, education, and income. Estimates were provided with 95% confidence intervals (CI). RESULTS 2,292 patients were identified with a mean WOOS index of 76 (standard deviation 24). In the adjusted analysis, unemployed patients had a significantly lower WOOS index compared with patients with low-level jobs (14, CI 7.0-21), patients with high-level jobs (19, CI 12-25), and retired patients (14, CI 8.3-21). Low education level was associated with a lower WOOS index compared with medium education (4.8, CI 2.6-7.0) and high education level (7.7, CI 5.0-10). There was no association between WOOS index and income or marital status. CONCLUSION Unemployment and low education level were associated with worse WOOS index 1 year after shoulder arthroplasty for osteoarthritis or cuff-tear arthropathy. This highlights a potential inequity in patient-reported outcomes after shoulder arthroplasty.
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Affiliation(s)
- Marie L Jensen
- Copenhagen University Hospital, Herlev and Gentofte, Denmark.
| | - Epaminondas M Valsamis
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Bo S Olsen
- Copenhagen University Hospital, Herlev and Gentofte, Denmark
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Romeo PV, Alben MG, Papalia AG, Chowdhury T, Cecora AJ, Ragland D, Kwon YW, Zuckerman JD, Virk MS. Addition of PROMIS pain instruments to PROMIS upper extremity physical function improves the responsiveness of PROMIS scores compared to legacy scores in patients undergoing total shoulder arthroplasty: a prospective study. J Shoulder Elbow Surg 2025:S1058-2746(25)00006-0. [PMID: 39756643 DOI: 10.1016/j.jse.2024.11.012] [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: 07/17/2024] [Revised: 10/31/2024] [Accepted: 11/06/2024] [Indexed: 01/07/2025]
Abstract
BACKGROUND Patient-Reported Outcome Measurement Information Systems (PROMIS) is increasingly being utilized across the United States as a patient-reported outcome evaluation tool for a wide variety of musculoskeletal conditions. However, PROMIS Upper Extremity (P-UE) physical function has demonstrated limited responsiveness in the early postoperative period after total shoulder arthroplasty (TSA). The aim of this study is to determine if addition of PROMIS Pain Interference (P-Interference) or Pain Intensity (P-Intensity) scores improve the ability to detect postoperative changes in the 1-year postoperative period following TSA. METHODS Patients who were indicated for and elected to undergo TSA between 2020 and 2022 were prospectively enrolled. Prospective data were collected for patient surveys (American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, P-UE, P-Interference and P-Intensity) at the 2-week, 6-week, 3-month, 6-month, and 12-month timepoints. Instrument responsiveness for each PROM was evaluated using the effect size (ES; Cohen d). Responsiveness was defined by the absolute values of each measurement, previously reported as small (0.2), medium (0.5), or large (0.8). Statistical analysis (2 sample t-tests and Fisher's tests) was performed using R studio version 4.2.3 (Boston, MA, USA). RESULTS A total of 127 subjects were enrolled in this study. All survey instruments demonstrated large responsiveness (>0.8) at 3, 6, and 12 months. P-Intensity was the only instrument to demonstrate large responsiveness at 2-weeks with its addition to P-UE showing an improved responsiveness at all-time points. Moreover, the addition of P-Intensity had a lower response burden at all-time points when compared to the legacy measures (ASES, Simple Shoulder Test, and Oxford Shoulder Score) at all-time points albeit no difference to ASES (P = .55) at 12-months after surgery. P-Interference and other legacy scores demonstrated large responsiveness starting at 6-weeks postoperatively. CONCLUSION The responsiveness of PROMIS UE can be improved by coupling the outcome measure to P-Intensity scores with a significantly lower response burden when compared to the legacy measures evaluated at nearly all time points.
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Affiliation(s)
- Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Tas Chowdhury
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew J Cecora
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Dashaun Ragland
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
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Meshram P, Łukasiewicz P, Okeke L, Srikumaran U, McFarland EG. Reverse shoulder arthroplasty for patients with cuff tear arthropathy: do clinical outcomes differ by inlay vs. onlay design? J Shoulder Elbow Surg 2024; 33:2604-2611. [PMID: 38754541 DOI: 10.1016/j.jse.2024.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres. METHODS This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N = 511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44 months; range, 24-125 months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences. RESULTS The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P = .04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P = .63), revision surgery (inlay, 0% vs. onlay 5.1%, P = .07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P = .63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P = .20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P = .08). CONCLUSION At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching.
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Affiliation(s)
- Prashant Meshram
- Department of Orthopedics, Apollo HealthCity Hospital, Jubilee Hills, Hyderabad, India
| | - Piotr Łukasiewicz
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Laurence Okeke
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Nyring MRK, Rasmussen JV, Gill DRJ, Harries D, Olsen BS, Page RS. Comparable low revision rates of stemmed and stemless total anatomic shoulder arthroplasties after exclusion of metal-backed glenoid components: a collaboration between the Australian and Danish national shoulder arthroplasty registries. J Shoulder Elbow Surg 2024; 33:2619-2628. [PMID: 38685378 DOI: 10.1016/j.jse.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The stemmed anatomic total shoulder arthroplasty is the gold standard in the treatment of glenohumeral osteoarthritis. However, the use of stemless total shoulder arthroplasties has increased in recent years. The number of revision procedures are relatively low, and therefore it has been recommended that national joint replacement registries should collaborate when comparing revision rates. Therefore, we aimed to compare the revision rates of stemmed and stemless TSA used for the diagnosis of glenohumeral osteoarthritis using data from both the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Danish Shoulder Arthroplasty Registry (DSR). METHODS We included all patients who were registered in the AOANJRR and the DSR from January 1, 2012, to December 2021 with an anatomic total shoulder arthroplasty used for osteoarthritis. Revision for any reason was used as the primary outcome. We used the Kaplan-Meier method to illustrate the cumulative revision rates and a multivariate cox regression model to calculate the hazard ratios. All analyses were performed separately for data from AOANJRR and DSR, and the results were then reported using a qualitative approach. RESULTS A total of 13,066 arthroplasties from AOANJRR and 2882 arthroplasties from DSR were included. The hazard ratio for revision of stemmed TSA with stemless TSA as reference, adjusted for age and gender, was 1.67 (95% confidence interval [CI] 1.34-2.09, P < .001) in AOANJRR and 0.57 (95% CI 0.36-0.89, P = .014) in DSR. When including glenoid type and fixation, surface bearing (only in AOANJRR), and hospital volume in the cox regression model, the hazard ratio for revision of stemmed TSA compared to stemless TSA was 1.22 (95% CI 0.85-1.75, P = .286) in AOANJRR and 1.50 (95% CI 0.91-2.45, P = .109) in DSR. The adjusted hazard ratio for revision of total shoulder arthroplasties with metal-backed glenoid components compared to all-polyethylene glenoid components was 2.54 (95% CI 1.70-3.79, P < .001) in AOANJRR and 4.1 (95% CI 1.92-8.58, P < .001) in DSR. CONCLUSION Based on data from 2 national shoulder arthroplasty registries, we found no significant difference in risk of revision between stemmed and stemless total shoulder arthroplasties after adjusting for the type of glenoid component. We advocate that metal-backed glenoid components should be used with caution and not on a routine basis.
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Affiliation(s)
- Marc R K Nyring
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, Denmark.
| | - Jeppe V Rasmussen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - David R J Gill
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Dylan Harries
- South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Bo S Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Richard S Page
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia; Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Deakin University, Geelong, VIC, Australia
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Aldon-Villegas R, Chamorro-Moriana G, Espuny-Ruiz F, Benitez-Lugo ML. Oxford Shoulder Instability Score: cross-cultural adaptation into Spanish and analysis of its methodological quality. BMC Musculoskelet Disord 2024; 25:946. [PMID: 39580411 PMCID: PMC11585154 DOI: 10.1186/s12891-024-08075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/13/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND Oxford Shoulder Instability Score (OSIS) is a patient reported outcome measure designed specifically to assess functional difficulties resulting from shoulder instability. The main aim of this study was to cross-culturally adapt the OSIS to Spanish. Secondary, it aimed to analyse its methodological quality. METHODS A cross-cultural adaptation to Spanish has been carried out following the recommendations of COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) with a sample of 167 cases of shoulder instability. Inclusion criteria were: subjects with instability symptoms in at least one shoulder with or without clinical diagnosis; aged between 18 and 60. The following psychometric properties were evaluated: validity (construct, internal and external), reliability (internal consistency, test-retest and measurement error), discriminant ability and feasibility. The methodological quality was addressed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and COSMIN Risk of Bias checklist (COSMIN RoB). RESULTS The construct validity obtained an OSIS correlation with the Simple Shoulder Test of r = 0.636 and with the Western Ontario Shoulder Instability of r = 0.80. The unidimensionality of the OSIS was confirmed through second-order factor analysis. Cronbach's alpha and intraclass correlation coefficient were both 0.93 (IC95%: 0.91-0.94). Standard error of measurement was 0.70, and the percentage of error and smallest detectable change were 1.46% and 1.94, respectively. No floor or ceiling effects were found. Assessing feasibility of OSIS, the participants answered all questions, had no questions and completion time was: mean 2 min 30 s; SD ± 1 min. Regarding methodological quality, the study showed low risk of bias in the areas of patient selection, index test, reference standard and flow and timing, as well as low concern regarding applicability in the domains of patient selection, index test and reference standard according to QUADAS-2. In relation to COSMIN RoB, all psychometric properties, except for content validity, obtained very good results. CONCLUSIONS The Spanish version of OSIS offers valid, reliable and feasible functional outcome measures for Spanish-speaking subjects with shoulder instability, based on its psychometric properties and its methodological quality.
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Affiliation(s)
- Rocio Aldon-Villegas
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, Seville, 41009, Spain
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, Seville, 41009, Spain.
| | - Fernando Espuny-Ruiz
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, Seville, 41009, Spain.
| | - Maria-Luisa Benitez-Lugo
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, Seville, 41009, Spain
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10
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Axenhus M, Ödquist M, Abbaszadegan H, Sköldenberg O, Salomonsson B. Glenoid wear and migration pattern of a humeral head resurfacing implant: a prospective study using radio stereometric analysis. JSES Int 2024; 8:1241-1247. [PMID: 39822831 PMCID: PMC11733553 DOI: 10.1016/j.jseint.2024.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2025] Open
Abstract
Background The humeral head resurfacing arthroplasty (HHR) is normally used as a hemi shoulder arthroplasty and has been in use for the treatment of Gleno-Humeral osteoarthritis (OA) of the shoulder for more than 30 years. Some studies, however, shows that anatomical total shoulder arthroplasty provides better improvement in function than a HHR for patients with OA. Reasons for this may be a progressive glenoid wear (GW) or loosening of the HHR. We, therefore, wanted to investigate the migration pattern of the HHR and also GW by using radio stereometric analysis (RSA). Methods 21 patients (21 shoulders) with OA and a mean age of 64 years were enrolled in the study. They all received the Copeland humeral resurfacing head and were followed for 2 years with RSA. We evaluated the clinical outcome at 2 years with Western Ontario Osteoarthritis of the Shoulder (WOOS), EuroQol 5 dimension 3L and Constant Shoulder Score. In addition, we assessed data on WOOS and revisions until 5 years follow-up by using the local clinic data within the Swedish Shoulder Arthroplasty Register. Results After an initial migration at two months the implants were stable in relation to the humerus with no statistically significant difference between the 2 months and the 2 years value (P = .23). The GW continued to increase during the study period with an initial migration of mean 2.3 mm and at 2 years 3.5 mm with a statistically difference between the 6 months and 2 years value (P = .046). The WOOS, EuroQol 5 dimension 3L and Constant Shoulder Score were all improved at 2 years compared to the preoperative values. We found a weak correlation between GW at 2 years and the WOOS score at 2 and 5 years, but these did not reach statistical significance. There were 4 revisions within 5 years after the primary operation, all due to pain. Conclusion The marker-free RSA can be used in clinical studies for assessing migration in HHR implants and was also for the first time used to measure GW. The Copeland HHR seems to obtain a secure fixation in the humerus but shows continuous GW up to two years.
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ödquist
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Hassan Abbaszadegan
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Salomonsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Blashinsky ZA, Latta S, Schurhoff MR, Vargas LA, Zvijac JE, Uribe JW. Inlay total shoulder arthroplasty in the weight-bearing shoulder of wheelchair-bound patients with paraplegia. A case report. Int J Surg Case Rep 2024; 124:110373. [PMID: 39388986 PMCID: PMC11562403 DOI: 10.1016/j.ijscr.2024.110373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 09/23/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Paraplegic patients' activities of daily living (ADLs) involve the use of manual wheelchairs that increase the stress on the shoulder joint. Patients with advanced glenohumeral changes are often resistant to conservative measures and may require surgical interventions. The longevity of a Total Shoulder Arthroplasty is largely unknown in paraplegics due to a lack of studies investigating outcomes in these patients. CASE PRESENTATION We examined the outcome of two paraplegic patients following inlay total shoulder arthroplasty (iTSA) with a non-spherical humeral head and glenoid inlay replacement. CLINICAL DISCUSSION Two patients with paraplegia and advanced degenerative joint disease who underwent iTSA were seen at regular follow-up intervals to assess range of motion, strength, and patient-reported outcome measures. Radiographic imaging was utilized to monitor slipping, lateralization, and degradation of the joint space. CONCLUSION Both patients have shown significant increases in strength, ROM, and PROMs. iTSA proved efficacious in paraplegic patients utilizing a manual wheelchair.
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Affiliation(s)
- Zachary A Blashinsky
- Florida International University Herbert Wertheim, College of Medicine, Miami, FL, USA
| | - Steven Latta
- Florida International University Herbert Wertheim, College of Medicine, Miami, FL, USA
| | - Matthias R Schurhoff
- Baptist Health Orthopedic Care, Baptist Health South Florida, Coral Gables, FL, USA
| | - Luis A Vargas
- Baptist Health Orthopedic Care, Baptist Health South Florida, Coral Gables, FL, USA.
| | - John E Zvijac
- Baptist Health Orthopedic Care, Baptist Health South Florida, Coral Gables, FL, USA
| | - John W Uribe
- Baptist Health Orthopedic Care, Baptist Health South Florida, Coral Gables, FL, USA
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12
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Bastard C, Sandman E, Chapleau J, Balg F, Léger St-Jean B, Blanchette D, Rouleau DM. Validity, reliability and responsiveness of a French translation of the Western Ontario Osteoarthritis of the Shoulder index (WOOS). Orthop Traumatol Surg Res 2024; 110:103912. [PMID: 38815666 DOI: 10.1016/j.otsr.2024.103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION While several general questionnaires can be used to evaluate shoulder conditions, very few tools specifically evaluate the impact of shoulder osteoarthritis. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) is a patient-reported outcome measure with excellent psychometric properties intended for patients suffering from shoulder osteoarthritis. Unfortunately, there is no validated French version of this questionnaire. OBJECTIVE Produce a validated French version of the WOOS that is suitable for the Francophone populations of Europe and North America. MATERIAL AND METHODS A validated protocol was used to create a French version of the WOOS (WOOS-Fr). Included were patients whose first language was French, who could read French and who had shoulder osteoarthritis destined for treatment (surgical treatment=arthroplasty). The WOOS-Fr was compared to the Disability of the Arm, Shoulder and Hand-French translation (F-QuickDASH-D/S) to assess its validity. Reliability and responsiveness were also analyzed. RESULTS A French version of the WOOS (WOOS-Fr) was accepted by a multinational committee. The WOOS-Fr was validated in 71 French-speaking subjects. A strong positive correlation was found between the WOOS-Fr and the F-QuickDASH-D/S during the initial evaluation. The intra-class correlation (ICC) of the total WOOS-Fr score indicated good reliability between the initial WOOS and the 1-week WOOS (ICC: 0.84; 95% CI: [0.767; 0.896]; p-value: <0.001) in 57 patients. The responsiveness between the initial WOOS-Fr and at 1 year postoperative was high in the 36 operated patients (standardized mean response of 1.95). DISCUSSION A French translation of the WOOS questionnaire was created and validated for use in French-speaking populations. This questionnaire will make it easier to evaluate the psychometric results of patients with shoulder osteoarthritis in Francophone countries. LEVEL OF EVIDENCE III; multicenter cohort study.
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Affiliation(s)
- Claire Bastard
- CIUSSS du Nord-de-l'Île-de-Montréal, hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal H4J 1C5, Canada; Hôpital Saint-Antoine, Paris, France
| | - Emilie Sandman
- CIUSSS du Nord-de-l'Île-de-Montréal, hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal H4J 1C5, Canada
| | - Julien Chapleau
- CIUSSS du Nord-de-l'Île-de-Montréal, hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal H4J 1C5, Canada
| | - Frédéric Balg
- CIUSSS-de-l'Estrie-CHUS, 3001, 12e, avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Benjamin Léger St-Jean
- CIUSSS-de l'Est-de-l'Île-de-Montréal, 5415, boulevard l'Assomption, Pavillon Rachel Tourigny, Montréal, QC H1T 2M4, Canada
| | - David Blanchette
- CIUSSS-de l'Est-de-l'Île-de-Montréal, 5415, boulevard l'Assomption, Pavillon Rachel Tourigny, Montréal, QC H1T 2M4, Canada
| | - Dominique M Rouleau
- CIUSSS du Nord-de-l'Île-de-Montréal, hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal H4J 1C5, Canada.
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Flinkkilä T, Vähäkuopus M, Sirniö K, Falkenbach P. Cost-effectiveness of shoulder arthroplasty for osteoarthritis and rotator cuff tear arthropathy. An economic analysis using real-world data. Orthop Traumatol Surg Res 2024; 110:103852. [PMID: 38428486 DOI: 10.1016/j.otsr.2024.103852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/18/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study aimed to assess cost-effectiveness of shoulder arthroplasty for osteoarthritis (OA) and rotator cuff tear arthropathy (CTA) from the perspective of a publicly funded health care system using patient data, health utilities and costs from a real-world situation. HYPOTHESIS Our hypothesis was that arthroplasty for OA is more cost-effective than for CTA. MATERIAL AND METHODS We gathered a cohort of patients with 153 anatomic total shoulder arthroplasty (TSA) for OA and 107 reverse shoulder arthroplasty (RSA) for CTA between years 2016-2020 at a university hospital. Short-term (mean 2.8years) shoulder function, health utilities and costs were obtained from prospectively collected data, and a Markov cohort simulation was carried out to assess lifetime cost-utility. The primary outcome measures were change in 15D score to calculate gain in quality-adjusted life years (QALYs) and change in Western Ontario osteoarthritis score of the shoulder (WOOS). RESULTS Both TSA and RSA restored shoulder function well, WOOS improvement was 59.7 (95% CI: 56.2-63.2) and 55.8 (95% CI: 50.4-61.2), respectively. The cost/QALY gained was 20,846.82 € for TSA and 38,711.90 € for RSA. The cost-utility was not remarkable sensitive to costs, discounting of future costs or estimated revision rates. However, the cost-effectiveness was very sensitive to change in 15D health utility scores and thus QALY gain, especially for RSA patients. DISCUSSION Shoulder arthroplasty restores shoulder function well in both OA and CTA. In health economic terms, RSA is less cost-effective than TSA in an everyday setting, mainly due to inferior improvement of health-related quality-of-life and reduced life expectancy of CTA patients. LEVEL OF EVIDENCE III; case series.
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Affiliation(s)
- Tapio Flinkkilä
- Oulu University Hospital and MRC Oulu, Surgery, Kajaanintie 50, 90029 Oulu, Finland.
| | - Marko Vähäkuopus
- Oulu University Hospital and MRC Oulu, Surgery, Kajaanintie 50, 90029 Oulu, Finland
| | - Kai Sirniö
- Oulu University Hospital and MRC Oulu, Surgery, Kajaanintie 50, 90029 Oulu, Finland
| | - Petra Falkenbach
- Oulu University Hospital, Finnish Coordinating Center for Health Technology Assessment, Oulu, Finland
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Chin PYK, Regan W, Plausinis D, Zarzour Z, Leung F, Johnston K, Lim B, Sasyniuk T. A multicenter, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed vs. cemented polyethylene glenoid component in total shoulder arthroplasty: 5-year results. J Shoulder Elbow Surg 2024; 33:1004-1016. [PMID: 38286183 DOI: 10.1016/j.jse.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Previously, we reported early (2-year) findings from a randomized controlled trial comparing a second-generation uncemented trabecular metal-backed (TM) glenoid vs. cemented polyethylene glenoid (POLY) in patients undergoing a total shoulder arthroplasty. The purpose of the current study is to report disease-specific quality of life, clinical, patient-reported, and radiographic outcomes at midterm (5-year) from this trial. METHODS Five surgeons from 3 centers participated. Patients 18-79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Randomization to an uncemented TM or cemented POLY glenoid was performed intra-operatively after adequate bone stock was confirmed. Study intervals were baseline, 2- and 5-year postoperative. The primary outcome was the Western Ontario Osteoarthritis Shoulder (WOOS) quality of life score. Secondary outcomes included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, EuroQol-5 Dimensions, and 12-Item Short Form Health Survey scores and clinical and radiographic examinations. Radiographic images were reviewed for metal debris according to Endrizzi. Mixed effects repeated measures analysis of variance for within- and between-group comparisons were performed. RESULTS Of the 104 patients who consented, 93 were randomized (46 TM; 47 POLY). There were no differences between groups at baseline (TM: mean age 66.5 years [standard deviation (SD) 6.4], 24 male and 22 female; and POLY: mean age 68.4 years [SD 5.5], 23 male / 24 female). Mean (SD) WOOS scores at baseline and 2 and 5 years were as follows: TM, 32 (21), 92 (13), and 93 (11); POLY, 27 (15), 93 (11), and 93 (10), respectively. No statistical or clinically relevant differences were noted with patient-reported outcomes between groups. Metal debris was observed in 11 (23.9%) patients, but outcomes were not negatively impacted, and debris severity was minor (grades 1 and 2). Complication rates were similar between groups (TM: 7 of 46 [15.2%], and POLY: 8 of 47 [17.0%]; P = .813). No aseptic glenoid failures were reported, but 1 patient in the TM group required revision because of infection. CONCLUSIONS Our short-term (2-year) findings were maintained with longer follow-up. At 5 years postoperation, there were no statistically or clinically significant differences between an uncemented second-generation TM glenoid and a cemented polyethylene glenoid with respect to disease-specific quality of life or patient-reported outcomes. No glenoid implant failures were reported, and complication rates were similar between groups. Only one complication was glenoid related (1 infection in the TM group). Metal debris was observed in 23.9% of patients with a TM glenoid but did not negatively influence implant survival, patient-reported outcomes, or shoulder function.
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Affiliation(s)
- Patrick Y K Chin
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - William Regan
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Derek Plausinis
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Zane Zarzour
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Department of Family Medicine, University of Victoria, Victoria, BC, Canada
| | - Fay Leung
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Kayla Johnston
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Brendan Lim
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Treny Sasyniuk
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
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15
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Olson JJ, Granger CJ, Hill JR, Aleem AW, Keener JD, Zmistowski BM. Revision of failed reverse total shoulder arthroplasty with reverse: short-term clinical outcomes. J Shoulder Elbow Surg 2024; 33:908-915. [PMID: 37648013 DOI: 10.1016/j.jse.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The prevalence of failed reverse total shoulder arthroplasty (rTSA) is increasing. This can often present a challenging clinical situation with substantial bone loss and limited reconstruction options. This study reports a single tertiary referral center's experience with revision of failed rTSA managed with revision rTSA of bone-interfacing components. METHODS After institutional review board approval, all revision shoulder arthroplasty cases performed at a single institution between 2012 and 2020 were reviewed. Cases in which rTSA was revised to a new rTSA construct with revision of at least 1 bone-interfacing implant (humeral stem and/or baseplate) with a minimum 2-year follow-up were identified. Characteristics of revision cases-including indications, bony stock, revised components, and use of bone graft-were collected. All patients were contacted for patient-reported outcome measures at a minimum of 2 years after surgery. In addition, the incidence and indication for any reoperation after revision were determined. RESULTS Thirty-three patients with an average age of 66 years (range: 46-82 years), with 19 (58%) being female, met the inclusion criteria and had a mean follow-up of 4.2 years (range: 2-8 years). The most common indication for revision rTSA included humeral component loosening (33%; 11/33), baseplate loosening (27%; 9/33), and instability (21%; 7/33). Prerevision infectious workup demonstrated no cases of periprosthetic shoulder infection. Thirteen cases had massive bone loss-5 treated with humeral allograft prosthetic composite, 5 with glenoid bone grafting, and 3 with custom glenoid implant. In total, 10 of 33 cases (30%) required reoperation at a mean of 13 months (range: 1-44 months) for instability (4), humeral loosening (2), infection (1), baseplate loosening (1), or periprosthetic fracture (1). The reoperation rate for patients with revised baseplates only, humerus only, or combined was 23% (3/13), 28% (5/18), and 27% (3/11), respectively. Overall, the visual analog scale pain score improved from 6.5 preoperatively to 2.0 (P < .001), and the American Shoulder and Elbow Surgeons score improved from 30.7 to 67.5 (P < .001). However, the postoperative Single Assessment Numeric Evaluation score averaged only 51.2% (range: 2-100%). CONCLUSION This study demonstrates that failed rTSA can be salvaged with a revision rTSA. However, patient expectations for functional improvements should be tempered, and a high reoperation rate should be expected.
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Affiliation(s)
- Jeffrey J Olson
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Caroline J Granger
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - J Ryan Hill
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Alexander W Aleem
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Benjamin M Zmistowski
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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Nyring MRK, Olsen BS, Amundsen A, Rasmussen JV. High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis. World J Orthop 2024; 15:156-162. [PMID: 38464358 PMCID: PMC10921174 DOI: 10.5312/wjo.v15.i2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The minimal clinically important difference (MCID) is defined as the smallest meaningful change in a health domain that a patient would identify as important. Thus, an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient. AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis. METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital, Denmark. The patients were evaluated preoperatively and 3 months, 6 months, 12 months, and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID. Based on previous literature, MCID for WOOS, OSS, and CMS were defined as 12.3, 4.3, and 12.8 respectively. RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis. Mean age at the time of surgery was 66 years (range 49.0-79.0, SD: 8.3) and 65% were women. One patient was revised within the two years follow-up. The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points [95% confidence interval (95%CI): 39.7-53.3, P < 0.005] for WOOS, 18.2 points (95%CI: 15.5-21.0, P < 0.005) for OSS and 37.8 points (95%CI: 31.5-44.0, P < 0.005) for CMS. Two years postoperatively, 41 patients (87%) had an improvement in WOOS that exceeded the MCID, 45 patients (94%) had an improvement in OSS that exceeded the MCID, and 42 patients (88%) had an improvement in CMS that exceeded the MCID. CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90% of patients has a clinically relevant improvement. This is a clear message when informing patients about their prognosis.
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Affiliation(s)
- Marc Randall Kristensen Nyring
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Bo Sanderhoff Olsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Alexander Amundsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Jeppe Vejlgaard Rasmussen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
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17
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Demir Y, Vuorinen A, Gordon M, Nordqvist A, Salomonsson B. Timing of Surgery for Proximal Humeral Fracture Treated with Shoulder Hemiarthroplasty, Best Results with Surgery Within 2 Weeks. Indian J Orthop 2024; 58:162-168. [PMID: 38312897 PMCID: PMC10830992 DOI: 10.1007/s43465-023-01079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/01/2023] [Indexed: 02/06/2024]
Abstract
Background Preoperative delay may affect the outcome of proximal humerus fractures treated with shoulder hemiarthroplasty. There is currently no consensus for the recommended preoperative time interval. The aim was to examine how the time to surgery with shoulder hemiarthroplasty after a proximal humerus fracture affected the patient-reported outcome. Methods 380 patients with proximal humerus fractures treated with shoulder hemiarthroplasty recorded from the Swedish Shoulder Arthroplasty Registry were included. Three self-reporting outcome instruments were used at follow-up after 1-5 years: a shoulder-specific score, the Western Ontario Osteoarthritis of the Shoulder index (WOOS), the EuroQol-5 Dimension index (EQ-5D), and subjective patient satisfaction assessment. Results The preoperative delay had a negative impact on the WOOS, EQ-5D, and patient satisfaction level (p < 0.01). The best result, measured with WOOS at a minimum 1-year follow-up, was found when surgery was performed 6-10 days after the reported date of fracture. WOOS% 8-14 days was 69.4% (± 24.2). A delay of more than 10 days was shown to be correlated with poorer outcomes. WOOS% 15-60 days was 55.8% (± 25.0) and continued to decrease. Conclusion The current recommendation in Sweden to perform shoulder hemiarthroplasty within 2 weeks after sustaining a proximal humerus fracture is considered valid.
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Affiliation(s)
- Yilmaz Demir
- Orthopedic Department, Danderyd Hospital, 182 88 Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | | | - Max Gordon
- Orthopedic Department, Danderyd Hospital, 182 88 Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | | | - Björn Salomonsson
- Orthopedic Department, Danderyd Hospital, 182 88 Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
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Löfstrand J, Paganini A, Grimby-Ekman A, Lidén M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg 2024; 111:znad296. [PMID: 37879120 PMCID: PMC10769156 DOI: 10.1093/bjs/znad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. METHOD This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). RESULTS A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. CONCLUSION Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Apiwatanakul P, Meshram P, Harris AB, Bervell J, Łukasiewicz P, Maxson R, Best MJ, McFarland EG. Use of custom glenoid components for reverse total shoulder arthroplasty. Clin Shoulder Elb 2023; 26:343-350. [PMID: 37957883 DOI: 10.5397/cise.2023.00563] [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: 06/28/2023] [Accepted: 09/02/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Our purpose was to evaluate a custom reverse total shoulder arthroplasty glenoid baseplate for severe glenoid deficiency, emphasizing the challenges with this approach, including short-term clinical and radiographic outcomes and complications. METHODS This was a single-institution, retrospective series of 29 patients between January 2017 and December 2022 for whom a custom glenoid component was created for extensive glenoid bone loss. Patients were evaluated preoperatively and at intervals for up to 5 years. All received preoperative physical examinations, plain radiographs, and computed tomography (CT). Intra- and postoperative complications are reported. RESULTS Of 29 patients, delays resulted in only undergoing surgery, and in three of those, the implant did not match the glenoid. For those three, the time from CT scan to implantation averaged 7.6 months (range, 6.1-10.7 months), compared with 5.5 months (range, 2-8.6 months) for those whose implants fit. In patients with at least 2-year follow-up (n=9), no failures occurred. Significant improvements were observed in all patient-reported outcome measures in those nine patients (American Shoulder and Elbow Score, P<0.01; Simple Shoulder Test, P=0.02; Single Assessment Numeric Evaluation, P<0.01; Western Ontario Osteoarthritis of the Shoulder Index, P<0.01). Range of motion improved for forward flexion and abduction (P=0.03 for both) and internal rotation up the back (P=0.02). Pain and satisfaction also improved (P<0.01 for both). CONCLUSIONS Prolonged time (>6 months) from CT scan to device implantation resulted in bone loss that rendered the implants unusable. Satisfactory short-term radiographic and clinical follow-up can be achieved with a well-fitting device. Level of evidence: III.
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Affiliation(s)
- Punyawat Apiwatanakul
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Prashant Meshram
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew B Harris
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Joel Bervell
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Piotr Łukasiewicz
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Ridge Maxson
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J Best
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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20
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Zbeda R, Asaid R, Warby SA, Cassidy JT, Hoy G. Medium-Term Clinical Outcomes of the Global Icon Stemless Shoulder System: Results of a 2-Year Follow-Up. J Clin Med 2023; 12:6745. [PMID: 37959211 PMCID: PMC10648431 DOI: 10.3390/jcm12216745] [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: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
The primary aim of this study was to assess the medium-term outcomes of the Global Icon stemless shoulder replacement in patients who have undergone primary total shoulder arthroplasty (TSA) for glenohumeral joint osteoarthritis. A retrospective review of patients who had undergone a TSA using the Global Icon stemless shoulder system was performed. The Western Ontario Osteoarthritis Shoulder (WOOS) Index and Oxford Shoulder Score (OSS) were evaluated pre-operatively and at 12 to 24 months post-operatively. Radiological outcomes, operation time, and post-operative complications were reported. Primary analysis for the WOOS Index and OSS focused on detecting within-group treatment effects at 24 months using a repeated measures ANOVA. Thirty patients were included in the study. Post-surgery, there was a significant improvement at 24 months on the OSS (ES = 0.932, CI: 41.7 to 47.7, p < 0.001) and the WOOS Index (ES = 0.906, CI: 71.9 to 99.8, p < 0.001). Radiographs revealed that no component loosened, migrated, or subsided. The median operative time was 75.5 (IQR: 12.25, range: 18 to 105) min. No implant-related complications were reported. The Global Icon stemless replacements have excellent clinical outcomes in this cohort at 12- and 24-month follow-up with no implant-related complications.
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Affiliation(s)
- Robert Zbeda
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Raf Asaid
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Sarah A. Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road, Bundoora, VIC 3080, Australia
| | - John Tristan Cassidy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
- Department of Surgery, Monash Medical Centre, Monash University, Level 5, Block E·246 Clayton Road, Clayton, VIC 3168, Australia
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21
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Ahmed AF, T Kreulen R, Mikula J, Nayar SK, Miller AS, McFarland EG, Srikumaran U. Subscapularis management in anatomic total shoulder arthroplasty: A systematic review and network meta-analysis. Shoulder Elbow 2023; 15:15-24. [PMID: 37692870 PMCID: PMC10492525 DOI: 10.1177/17585732221114816] [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: 03/03/2022] [Revised: 06/08/2022] [Accepted: 07/02/2022] [Indexed: 09/12/2023]
Abstract
Background This systematic review and network meta-analysis compare clinical outcomes of three different subscapularis management techniques in anatomic total shoulder arthroplasty: lesser tuberosity osteotomy, subscapularis peel, and subscapularis tenotomy. Methods PubMed, Web of Science, Embase, and Cochrane's trial registry were searched in July 2021. Comparative studies and case series evaluating the outcomes of these three techniques were included. The network meta-analysis was performed only on comparative studies. Results Twenty-three studies were included. Both lesser tuberosity osteotomy and subscapularis peel had significantly higher Western Ontario Osteoarthritis Scores compared to subscapularis tenotomy, but no difference in American Shoulder and Elbow Society Scores. Subscapularis peel had superior external rotation compared to lesser tuberosity osteotomy. However, no difference was found in external rotation between subscapularis peel and subscapularis tenotomy or between subscapularis tenotomy and lesser tuberosity osteotomy. The overall weighted average for lesser tuberosity osteotomy bony union was 93.6%, whereas the overall weighted average for subscapularis tendon healing was 79.4% and 87% for subscapularis tenotomy and subscapularis peel, respectively. Discussion This network meta-analysis demonstrated that lesser tuberosity osteotomy and subscapularis peel were associated with the high union and subscapularis healing rates and may be associated with improved shoulder function and quality of life, compared to subscapularis tenotomy. Lesser tuberosity osteotomy and subscapularis peel demonstrate a trend of superior outcomes compared to subscapularis tenotomy during anatomic total shoulder arthroplasty.
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Affiliation(s)
- Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Randall T Kreulen
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Jacob Mikula
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Andrew S Miller
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Howard County General Hospital, Columbia, MD, USA
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22
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Baumgarten KM. Patients who have intraoperative deviations in their preoperative plan have inferior clinical and radiographic outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:e451-e463. [PMID: 36868298 DOI: 10.1016/j.jse.2023.01.035] [Citation(s) in RCA: 2] [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: 11/07/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Three-dimensional computed tomography preoperative planning has become adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients in whom the surgeon implanted prostheses that deviated from the preoperative plan compared with patients in whom the surgeon followed the preoperative plan. The hypothesis of this study was that clinical and radiographic outcomes would be equivalent between patients undergoing anatomic total shoulder arthroplasty that had a deviation in the components predicted in the preoperative plan and patients who did not have a change in the components predicted in the preoperative plan. METHODS A retrospective review of patients who had preoperative planning for anatomic total shoulder arthroplasty from March 2017 through October 2022 was performed. Patients were stratified into 2 groups: patients in whom the surgeon used components that deviated from those anticipated by the preoperative plan (changed group), and patients in whom the surgeon used all of the components anticipated by the preoperative plan (planned group). Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test (SST), and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. RESULTS A total of 159 patients had intraoperative changes to their preoperative plan, and 136 patients underwent arthroplasty without changes to their preoperative plan. The planned group had higher scores than the group that had a deviation in the preoperative plan for every patient-determined outcome metric at every postoperative time point with statistically significant improvements found in the SST and Single Assessment Numeric Evaluation at 1-year and the SST and American Shoulder and Elbow Surgeons score at 2-year follow-up. No differences were found in range of motion metrics between the groups. Patients who did not have a deviation in their preoperative plan had more optimal restoration of their postoperative radiographic center of rotation than patients who did have a deviation in their preoperative plan. CONCLUSIONS Patients who have intraoperative changes to their preoperative plan have (1) inferior postoperative patient-determined outcome scores at 1 and 2 years after surgery and (2) a larger deviation in the postoperative radiographic restoration of the humeral center of rotation than patients who did not have intraoperative changes from the initial plan.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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23
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Rasmussen JV, Amundsen A, Petersen JK, Issa Z, Olsen BS. Stemmed hemiarthroplasty with a suture collar and a common platform system for acute proximal humeral fractures. JSES Int 2023; 7:607-613. [PMID: 37426938 PMCID: PMC10328766 DOI: 10.1016/j.jseint.2023.03.003] [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] [Indexed: 07/11/2023] Open
Abstract
Background Hemiarthroplasty for acute proximal humeral fractures gives disappointing results, often due to rotator cuff insufficiency. Better tuberosity fixation might improve results. Therefore, the aim of this study was to: 1) report the outcome of a stemmed hemiarthroplasty with a common platform system and a modular suture collar; 2) compare the outcome with that of a standard stemmed hemiarthroplasty; 3) report the feasibility of revision arthroplasty with retention of the stem; and 4) to evaluate the association between tuberosity healing and functional outcome. Methods Forty-four fractures that were deemed not suitable for nonsurgical treatment or open reduction and internal fixation were treated with the Global Unite fracture system between January 2017 and July 2019. The functional and radiographic results at 2 years were compared with the results of 44 Global Fx arthroplasties. The results of patients who had adequate healing of the greater tuberosity were compared with the results of patients who had severe malunion or nonunion (resorption). Results Mean Oxford Shoulder Score, Constant-Murley Score, and Western Ontario Osteoarthritis of the Shoulder index was 33 (range: 10 to 48), 40 (range: 10 to 98), and 68 (range: 18 to 98) at 2 years. There were no differences in functional outcome scores or in the risk of inadequate healing of the greater tuberosity between the Global Unite and the Global Fx systems. Five (11%) patients underwent revision surgery with retention of the stem. Inadequate tuberosity healing was associated with an inferior Constant-Murley Score (mean difference: 6; 95% confidence interval: 1 to 10, P = .01) and an inferior Oxford Shoulder Score (mean difference: 9; 95% confidence interval: 1 to 16, P = .03). Conclusion The use of stemmed hemiarthroplasty with a suture collar did not improve the healing of the greater tuberosity or the functional outcome. Five arthroplasties were revised with retention of the stem. This possibility could be arguments for using the Global Unite system when a stemmed hemiarthroplasty is used for acute proximal humeral fractures.
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Affiliation(s)
- Jeppe V. Rasmussen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Amundsen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - John K. Petersen
- Department of Orthopedic Surgery, Zealand University Hospital, Koge, Denmark
| | - Zaid Issa
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Zealand University Hospital, Koge, Denmark
| | - Bo S. Olsen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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24
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Michener LA, Heitzman J, Abbruzzese LD, Bondoc SL, Bowne K, Henning PT, Kosakowski H, Leggin BG, Lucado AM, Seitz AL. Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association. Phys Ther 2023; 103:pzad041. [PMID: 37115808 PMCID: PMC10256270 DOI: 10.1093/ptj/pzad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/02/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for physical therapist management of glenohumeral joint osteoarthritis. This clinical practice guideline is available in Spanish; see Supplementary Appendix 8.
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Affiliation(s)
- Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jill Heitzman
- Physical Therapy Program, Maryville University, St Louis, Missouri, USA
| | - Laurel D Abbruzzese
- Programs in Physical Therapy, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York City, New York, USA
| | - Salvador L Bondoc
- School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania, USA
| | - Kristin Bowne
- Kristin Bowne Physical Therapy Inc, Napa, California
, USA
| | - Phillip Troy Henning
- Swedish Spine, Sports & Musculoskeletal Medicine - Issaquah, Seattle, Washington, USA
| | | | - Brian G Leggin
- Good Shepherd Penn Partners, Penn Therapy and Fitness, Philadelphia, Pennsylvania, USA
| | - Ann M Lucado
- Department of Physical Therapy, College of Health Professions, Mercer University, Macon, Georgia, USA
| | - Amee L Seitz
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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25
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Demir Y, Sjöberg H, Stark A, Salomonsson B. Western Ontario Osteoarthritis of the Shoulder Index (WOOS) - a validation for use in proximal humerus fractures treated with arthroplasty. BMC Musculoskelet Disord 2023; 24:450. [PMID: 37268955 PMCID: PMC10236693 DOI: 10.1186/s12891-023-06578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/29/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The Swedish shoulder and Arthroplasty Registry (SSAR) use the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) as their shoulder-specific score in the follow-up. WOOS is not yet validated for use as the Patient Reported Outcome Measurement (PROM) for proximal humerus fractures (PHF) treated with shoulder hemiarthroplasty (SHA) in the Swedish registry. The aim of this study was to examine the validity, the reliability and the responsiveness of WOOS as a PROM for proximal humerus fractures treated with shoulder arthroplasty. METHODS Data was collected from the SSAR from the 1st of January 2008 to the 31st of June 2011. A total of 72 subjects were identified with at least 1 year of follow-up. Of these 43 completed all the shoulder-specific PROM together with a clinical examination, including a WOOS retest and general health scores. A group of 29 did not undergo any clinical examination, but they completed all the questionnaires not requiring a clinical examination. The validity was assessed with WOOS compared to satisfaction level, and the Spearman rank coefficient was used for the correlation between WOOS and the shoulder-specific scores (Constant-Murley Score, Oxford Shoulder Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and EQ-5D. For reliability, Intra Class Correlation (ICC) was used for the test-retest assessment and Cronbach´s alpha for the construct reliability. RESULTS The validity for WOOS had an excellent correlation (> 0.75) with all the shoulder-specific scores and a good correlation (> 0.6) with EQ-5D. The reliability with the test-retest of the total WOOS score and the subgroups had an excellent correlation. Cronbach´s alpha also supports the construct of WOOS. There were no floor or ceiling effects. CONCLUSIONS We found that WOOS is a reliable tool for evaluating patients with SHA after PHF. Based on our study, we recommend the continued use of WOOS in shoulder arthroplasty registries and observational studies.
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Chalmers PN, Tashjian RZ, Keener JD, Sefko JA, Da Silva A, Morrissey C, Presson AP, Zhang C, Chamberlain AM. Active physical therapy does not improve outcomes after reverse total shoulder arthroplasty: a multi-center, randomized clinical trial. J Shoulder Elbow Surg 2023; 32:760-770. [PMID: 36690173 DOI: 10.1016/j.jse.2022.12.011] [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: 09/18/2022] [Revised: 11/20/2022] [Accepted: 12/11/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare range of motion (ROM) and patient-reported outcomes (PROs) between a structured home exercise program (HEP) and active, supervised physiotherapy (PT) after primary Reverse total shoulder arthroplasty (RTSA) by performing a multicenter randomized clinical trial. METHODS Patients undergoing primary RTSA at 2 centers were randomized to either a HEP group, in which they were given a handout and a rope pulley, or a PT group, in which they were given a standardized prescription. Surgical technique and implants were standardized. At baseline, 6 weeks, 3 months, and 1 year postoperatively, we obtained American Shoulder and Elbow Surgeons scores, Western Ontario Osteoarthritis Scores, visual analogue scale for pain scores, and measured ROM via videotape. On video, ROM was then measured by blinded observers. At all study visits, patients were asked how many days per week they were in PT and how many days a week they completed HEP to determine compliance and crossover. An a priori power analysis suggested 29 patients per group, 56 patients total to detect a difference of 30° in active forward elevation with a power of 0.8 at a 2-sided alpha of 0.05. RESULTS 89 patients were randomized, 43 to PT, and 46 to HEP. We obtained 1-year PRO follow-up on 83 patients (93%) and ROM follow-up on 73 patients (82%). Nine patients (20%) crossed over from HEP to PT and 2 patients (4%) crossed over from PT to HEP. Complications occurred in 13% of HEP and 17% of PT patients (P = .629). Using mixed models that account for baseline values, there were no significant differences between groups in PROs or ROM at final follow-up. CONCLUSION In this 2-center, randomized clinical trial, there were no significant differences in patient outcomes or ROM between HEP and PT after RTSA. These findings suggest that it may not be necessary to recommend PT as a protocol for all patients after RTSA.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julianne A Sefko
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adrik Da Silva
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Caellagh Morrissey
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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27
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Baumgarten KM. Is stemless total shoulder arthroplasty indicated in elderly patients? J Shoulder Elbow Surg 2023; 32:260-268. [PMID: 36162630 DOI: 10.1016/j.jse.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Stemmed anatomic total shoulder arthroplasty has represented the gold standard for the treatment of glenohumeral osteoarthritis with an intact rotator cuff for decades. To the author's knowledge, no study has specifically examined the outcomes of stemless, modular total shoulder arthroplasty in elderly patients. The hypothesis of this study was that stemless anatomic total shoulder arthroplasty in elderly patients (age ≥70 years) would have equivalent clinical and radiographic outcomes compared with a younger population (age <70 years). MATERIALS AND METHODS A prospectively collected database of patients undergoing primary, modular, stemless anatomic total shoulder arthroplasty for osteoarthritis was retrospectively reviewed. Patient-determined outcomes including the Western Ontario Osteoarthritis Index (WOOS) score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Simple Shoulder Test score, and Shoulder Activity Level score were recorded preoperatively and postoperatively at 1 year and 2 years. Preoperative and 1-year postoperative range of motion was recorded. Postoperative radiographs were examined to assess for radiographic evidence of complications. RESULTS Stemless arthroplasty was planned in 116 patients. Seven patients underwent conversion intraoperatively to a stemmed prosthesis. There was no difference between patients aged <70 yr and those aged ≥70 years who required intraoperative deviation from the preoperative plan to a stemmed prosthesis (5.8% vs 6.4%, P = .90). At the time of stemless arthroplasty, 64 patients were aged <70 yr and 44 patients were aged ≥70 years. Between the 2 groups, there were no clinically or statistically significant differences in WOOS, ASES, and SANE scores at baseline, 1-year follow-up, or 2-year follow-up. The changes in all scores from baseline to 2 years were similar between the group aged <70 yr and the group aged ≥70 years. There was no difference in the percentage of patients achieving the minimal clinically important difference or substantial clinical benefit in either group after shoulder arthroplasty at 2-year follow-up. There was no difference between the 2 groups in terms of final postoperative range of motion or change in range of motion for any metric examined. There was no evidence of radiographic complications in either group. CONCLUSIONS Age ≥70 years does not appear to be a contraindication to stemless anatomic total shoulder arthroplasty. Postoperative improvements in patient-determined outcome scores, the percentage of patients achieving clinically important outcomes for the ASES, SANE, and WOOS scores, and postoperative range of motion were similar between patients aged <70 yr and those aged ≥70 years. There was no difference between the groups regarding the patients who required intraoperative deviation from the preoperatively planned stemless prosthesis to a stemmed prosthesis. Neither age group demonstrated a radiographically apparent complication.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Baisi LP, Athwal GS, Pollock JW, Zhang T, Hodgdon T, McIlquham K, Lapner P. Ultrasound-determined healing rates with subscapularis tenotomy versus peel after anatomic shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:96-103. [PMID: 35973515 DOI: 10.1016/j.jse.2022.07.003] [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: 03/04/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several techniques have been described for mobilizing the subscapularis tendon in anatomic total shoulder arthroplasty (TSA). The purpose of this study was to compare subscapularis tendon healing rates, as determined by ultrasound, in patients following anatomic TSA with either a subscapularis tenotomy or subscapularis peel. METHODS This study was a secondary analysis of patients from a previous randomized controlled trial in which patients underwent anatomic TSA and were randomized to either a tenotomy or peel approach. The primary outcome was postoperative tendon healing rates determined on ultrasound at >12 months after surgery. Secondary outcomes included postoperative tendon thickness measured on ultrasound; elbow position (neutral alignment in the belly-press position vs. posterior); internal rotation function measured with the third and fourth questions of the American Shoulder and Elbow Surgeons questionnaire; and Western Ontario Osteoarthritis of the Shoulder index. Radiographs were analyzed in patients with torn tendons. RESULTS One hundred patients were randomized to a tenotomy (n = 47) or peel (n = 53) approach. Postoperative ultrasound results were available in 88 patients. Tendon healing rates were 95% for tenotomy vs. 75% for peel (P = .011). The mean postoperative tendon thickness was 4 mm (standard deviation, 1.0 mm) and 4 mm (standard deviation, 1 mm) in the tenotomy and peel groups, respectively (P = .37). Internal rotation function was not associated with healing status (P = .77 and P = .22 for questions 3 and 4, respectively, of the American Shoulder and Elbow Surgeons questionnaire), nor was elbow position (P = .2) in the belly-press position. DISCUSSION We observed that subscapularis tenotomy had a higher healing rate than peel as determined by ultrasound in TSA patients. There was no statistically significant difference in postoperative tendon thickness in intact tendons as measured on ultrasound when comparing subscapularis mobilization techniques, nor was there any association between healing status and internal rotation function or elbow position.
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Affiliation(s)
- Louis-Philippe Baisi
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada; Western University, London, ON, Canada
| | - J Whitcomb Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Taryn Hodgdon
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Katie McIlquham
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Gumbie M, Costa M, Erb M, Dissanayake G. Innovative technologies for reverse total shoulder arthroplasty in Australia: Market access challenges and implications for patients, decision-makers, and manufacturers. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2022; 11:2154420. [PMID: 36506841 PMCID: PMC9731581 DOI: 10.1080/20016689.2022.2154420] [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: 08/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The success of reverse total shoulder arthroplasty (RTSA) has expanded its use for a broader range of shoulder indications worldwide. Evidence regarding the relative efficacy and long-term safety of medical technologies used in RTSA is subjected to rigorous assessment. Nonetheless, substantial challenges impede market access for innovative shoulder implant technologies for RTSA in Australia, resulting in delayed patient access. APPROACH This paper addresses the key challenges associated with generating evidence for the health technology assessments of innovative medical technologies for RTSA that are required for access to the Australian market. The transition to value-based care requires establishing a benchmarking reference that incorporates patient-reported outcome measures (PROMs) and combines revision outcomes with additional clinical outcomes to increase patient cohort sizes. Establishing the benchmark would require agreement on the outcome measures to be collected for each indication, and investment in reporting patient-reported outcomes for RTSA to the national orthopaedic registry. IMPLICATIONS FOR PRACTICE The need for increased flexibility in developing evidence for health technology assessment of RTSA medical technologies is required. Optimised approaches for benchmarking RTSA require extensive stakeholder discussions, including the agreement on evidence requirements and follow-up periods, selection of clinical outcomes, as well as pre-operative and post-operative PROMs as a value assessment.
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Affiliation(s)
- Mutsa Gumbie
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
- Johnson & Johnson MedTech, North Ryde, NSW, Australia
| | | | | | - Gnanadarsha Dissanayake
- New South Wales Ministry of Health, St Leonards, NSW, Australia
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia
- Statistical Society of Australia, Belconnen, NSW, Australia
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Wilcox B, Campbell RJ, Low A, Yeoh T. Management of glenoid bone loss in primary reverse shoulder arthroplasty. Bone Joint J 2022; 104-B:1334-1342. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0819.r1] [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: 12/03/2022]
Abstract
Aims Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. Methods This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates. Results A total of 13 studies (919 shoulders) were included in the analysis. The mean age of patients at initial evaluation was 72.2 years (42 to 87), with a mean follow-up time of 40.7 months (24 to 120). Nine studies with 292 rTSAs evaluated the use of bone graft and five studies with 627 rTSAs evaluated the use of augmented glenoid baseplates. One study was analyzed in both groups. Both techniques demonstrated improvement in patient-reported outcome measures and ROM assessment, with augmented prostheses outperforming bone grafting on improvements in the American Shoulder and Elbow Surgeons Score. There was a higher complication rate (8.9% vs 3.5%; p < 0.001) and revision rate among the bone grafting group compared with the patients who were treated with augmented prostheses (2.4% vs 0.6%; p = 0.022). Conclusion This review provides strong evidence that both bone graft and augmented glenoid baseplate techniques to address glenoid bone loss give excellent ROM and functional outcomes in primary rTSA. The use of augmented base plates may confer fewer complications and revisions. Cite this article: Bone Joint J 2022;104-B(12):1334–1342.
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Affiliation(s)
- Ben Wilcox
- Department of Orthopaedics, John Hunter Hospital, Newcastle, Australia
| | - Ryan J. Campbell
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Adrian Low
- University of Sydney, Sydney, Australia
- Department of Orthopaedic Surgery, Sydney Adventist Hospital, Sydney, Australia
| | - Timothy Yeoh
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Sydney, Australia
- Norwest Private Hospital, Sydney, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
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Wiitavaara B, Florin J. Content and psychometric evaluations of questionnaires for assessing physical function in people with arm-shoulder-hand disorders. A systematic review of the literature. Disabil Rehabil 2022; 44:7575-7586. [PMID: 34560830 DOI: 10.1080/09638288.2021.1979109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim was to investigate how structured assessment of physical function can be performed in people with musculoskeletal disorders in arm-shoulder-hand. Specifically, we aimed to determine:• Which questionnaires are available for structured assessment of physical function in people with musculoskeletal disorders in arm-shoulder-hand?• What aspects of physical function do those questionnaires measure?• What are the psychometric properties of the questionnaires? MATERIALS AND METHODS By means of a systematic review, questionnaires and psychometric tests of those were identified. ICF was used to categorise the content of the questionnaires, and the COSMIN checklist was used to assess the psychometric evaluations. RESULTS Nine questionnaires were identified. Most items focused on activities rather than functions. Commonly, a couple of psychometric measurements had been tested, most often reported being adequate. Only one questionnaire had been tested for all aspects. Variation in scope and insufficient reports regarding validity and reliability make comparisons and decisions on use difficult both in clinical practice and for research purposes. CONCLUSIONS The level of psychometric evaluation differs, and often only a few aspects of validity and reliability have been tested. The questionnaires address activity issues to a higher extent than function.IMPLICATIONS FOR REHABILITATIONThis review investigates the content and quality of nine ASH questionnaires.The questionnaires addressed activity issues to a higher extent than function.The level of psychometric testing of the questionnaires differed.DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results.
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Affiliation(s)
- Birgitta Wiitavaara
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Jan Florin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska University Hospital, Stockholm, Sweden
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Tøttrup M, Thillemann JK, Thillemann TM, Mechlenburg I, Klebe T, Søballe K, Stilling M. Early offset-increasing migration predicts later revision for humeral head resurfacing implants. A randomized controlled radiostereometry trial with 10-year clinical follow-up. J Orthop Res 2022; 40:2688-2697. [PMID: 35220595 DOI: 10.1002/jor.25298] [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: 08/26/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
In a randomized controlled setting, medium-term implant migration and long-term clinical outcomes were compared for the Copeland and the Global C.A.P. humeral head resurfacing implants (HHRI). Thirty-two patients (mean age 63 years) were randomly allocated to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were followed for 5 years with radiostereometry, Constant Shoulder Score, and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). WOOS and revision status were also obtained cross-sectionally at a mean 10-year follow-up. At the 5-year follow-up, total translation (TT) was 0.75 mm (95% confidence interval [CI]: 0.53-0.97) for the Copeland HHRIs and 1.15 mm (95% CI: 0.85-1.46) for the Global C.A.P. HHRIs (p = 0.04), but the clinical scores were similar at all follow-ups. The cumulative risks of revision at 5 and 10 years were 29% and 43% for Copeland and 35% and 41% for Global C.A.P HHRIs (p > 0.7). No implants were loose at revision, but HHRIs that were later revised followed an early offset-increasing migration pattern with medial translation and lift-off resulting in a mean 0.53 mm (95% CI: 0.18-0.88) higher TT at the 1-year follow-up compared to non-revised HHRIs. In conclusion, the Global C.A.P. HHRI had higher TT compared with the Copeland HHRI, but clinical scores and revision rates were similar. Nonetheless, revision rates were high and challenge the use of HHRIs. Interestingly, an early radiostereometry evaluated HHRI migration pattern with increased off-set predicted later implant revision.
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Affiliation(s)
- Mikkel Tøttrup
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Farsø, Denmark
| | - Janni Kjaergaard Thillemann
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Hospital Unit West, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark
| | - Theis Muncholm Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thomas Klebe
- Department of Orthopaedics, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Oak SR, Kobayashi E, Gagnier J, Denard PJ, Sears BW, Gobezie R, Lederman E, Werner BC, Bedi A, Miller BS. Patient Reported Outcomes and Range of Motion After Reverse Total Shoulder Arthroplasty With and Without Subscapularis Repair. JSES Int 2022; 6:923-928. [PMID: 36353412 PMCID: PMC9637760 DOI: 10.1016/j.jseint.2022.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In performing reverse total shoulder arthroplasty (rTSA), the role of repairing the subscapularis has been debated. Our objective was to determine the effect of subscapularis repair following rTSA on postoperative shoulder ranges of motion and patient reported outcome scores (PROs). Methods A prospective registry was reviewed to establish a cohort of primary rTSA patients with a 135-degree humeral implant, with a minimum of 2 years of follow-up. Variables collected included demographics, subscapularis repair information, diagnosis, glenosphere size, and glenoid lateralization information. Outcomes collected were range of motion measurements, subscapularis strength, and multiple generic and shoulder PROs. Multivariable linear regression models were created to predict these 2-year outcomes. Results The 143-patient cohort had a mean age of 69 years with 68% of patients undergoing subscapularis repair. After adjustment in the multivariable models, whether the subscapularis was repaired did not significantly predict a 2-year forward elevation, external rotation, internal rotation, subscapularis strength, Western Ontario Osteoarthritis of the Shoulder score, VR-12 scores, Constant Score, or American Shoulder and Elbow Surgeons Shoulder Scores. Increased glenoid lateralization significantly predicted greater internal rotation, higher VR-12 physical score, and higher Constant Score. There were no dislocations in either group. Conclusions After adjusting for patient and implant factors, subscapularis repair was not associated with a 2-year postoperative range of motion, strength, or any PROs suggesting that repairing the subscapularis may not affect functional outcome. Increased glenoid lateralization through the baseplate and glenosphere independently predicted better internal rotation, VR-12 physical score, and Constant Scores indicating a benefit to lateralization during rTSA.
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Affiliation(s)
- Sameer R. Oak
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | | | - Joel Gagnier
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Asheesh Bedi
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | - Bruce S. Miller
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
- Corresponding author: Bruce S. Miller, MD, University of Michigan Orthopaedic Surgery Department, 24 Frank Lloyd Wright Dr Ste 1000, Lobby A, Ann Arbor, MI 48105, USA.
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Jensen ML, Olsen BS, Nyring MRK, Yilmaz M, Petersen MM, Flivik G, Rasmussen JV. Implant migration and functional outcome of Reverse Shoulder Lateralized Glenosphere Line Extension System: a study protocol for a randomized controlled trial. Trials 2022; 23:579. [PMID: 35854390 PMCID: PMC9295266 DOI: 10.1186/s13063-022-06482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Inferior scapular notching is a complication unique to reverse shoulder arthroplasty. The most efficient technique to avoid inferior scapular notching has been reported to be lateralization of the glenoid offset. This study aims to compare radiological and functional outcomes of the DELTA Xtend® Reverse Shoulder System Lateralized Glenosphere Line Extension (intervention group) with the Standard DELTA Xtend® Reverse Shoulder System (control group). We hypothesize that the lateralization improves the patient outcome by decreasing the risk of inferior scapular notching without increasing the risk of migration and loosening of glenoid component. METHODS In this randomized controlled trial, all Danish citizens with rotator cuff arthropathy or degeneration of the glenohumeral joint with severe posterior wear and allocated for a reverse total shoulder arthroplasty at the department of orthopaedic surgery at Herlev and Gentofte Hospital, Copenhagen University Hospital, will be considered for participation. The exclusion criteria are as follows: below 50 years of age, cognitive or linguistic impairment, insufficient glenoid bone stock, previous fracture in the upper extremity and autoimmune-mediated inflammatory arthritis. There will be included a total of 122 patients of which 56 will participate in the radiostereometric analysis. This number of patients allows 20% to drop out. The co-primary outcomes are the pattern and magnitude of the migration of the glenoid component assessed by radiostereometric analysis and the Western Ontario Osteoarthritis of the Shoulder index. The secondary outcomes are inferior scapular notching, patient-reported and functional outcomes (Oxford shoulder score, Constant-Murley score and pain), side effects and complications, changes in bone mineral density and economy. The included patients will be examined before the surgery, within 1 week and 3, 6, 12 and 24 months after. DISCUSSION No previous studies have compared the conventional reverse shoulder arthroplasty with the lateralized reverse shoulder arthroplasty in a randomized controlled trial regarding migration and functional outcome. Furthermore, radiostereometric analysis has not been used to evaluate the migration of reverse shoulder arthroplasty in a randomized controlled trial. This study intends to determine which treatment has the most optimal outcome for the benefit of future patients with an indication for reverse shoulder arthroplasty. TRIAL REGISTRATION The study has been notified to Pactius and has approval number P-2021-231. Furthermore, the study will be registered on Clinicaltrials.gov before starting the inclusion.
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Affiliation(s)
- Marie Louise Jensen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Bo S Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marc R K Nyring
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Müjgan Yilmaz
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael M Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Flivik
- Department of Orthopedic Surgery, Skaane University Hospital, Lund University, Lund, Sweden
| | - Jeppe V Rasmussen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hallberg K, Salomonsson B. Validity, reliability, and responsiveness of the Swedish version of Western Ontario Osteoarthritis of the Shoulder index. BMC Musculoskelet Disord 2022; 23:351. [PMID: 35410269 PMCID: PMC8996484 DOI: 10.1186/s12891-022-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background The Western Ontario of the Shoulder index (WOOS) is a patient-reported, disease-specific instrument, designed to measure quality of life in patients with osteoarthritis of the shoulder. The Swedish Shoulder Arthroplasty Registry (SSAR) uses WOOS and EuroQoL 5-dimensions 3 levels (EQ-5D-3L) as patient reported outcome measures. The purpose of this study was to test the validity, responsiveness, and reliability of the Swedish translation of WOOS for patients with osteoarthritis of the shoulder. Methods Data was collected from three shoulder arthroplasty studies performed during 2005–2013, with 23, 21, and 19 patients respectively. Forms were collected preoperatively, and postoperatively between 12 and 24 months. WOOS and EQ-5D-3L were used in all three studies. Additionally, the Oxford Shoulder Score (OSS) (n = 23) was used in one study, and the Constant-Murley score (CMS) (n = 40) in two of the studies. Validity was analysed by calculating Pearson’s correlation coefficient (PCC). Cronbach’s alpha (CA) was used to estimate internal consistency and reliability. The responsiveness of WOOS was measured by calculating effect size and standardized response mean. To assess the performance of WOOS over time, we present repeated measures of WOOS in the registry over a 10-year period. Results The validity analysis showed excellent correlations of WOOS to CMS, OSS and EQ-5D 3L, with Pearson’s correlation coefficient of 0.72, 0.83, and 0.62 respectively (P < 0.001). There were adequate floor effects in the sport and lifestyle domains preoperatively, and adequate ceiling effects in all domains postoperatively. There were no floor effects and adequate ceiling effects for total WOOS. Analyzing reliability, Cronbach’s alpha was 0.95 for the pre- and postoperative WOOS scores combined. The analysis of responsiveness for WOOS showed an effect size of 2.52 and a standardized response mean of 1.43. The individual results measured by WOOS within the registry shows stable levels from 1 to 10 years. Conclusion The Swedish translation of WOOS is valid, reliable, and responsive for use in a clinical setting for patients with glenohumeral osteoarthritis treated with shoulder arthroplasty, and we regard it as an appropriate instrument for use in the Swedish Shoulder Arthroplasty Registry.
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Affiliation(s)
- Kristofer Hallberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden. .,Division of Orthopaedic Surgery, Danderyd hospital, Stockholm, Sweden.
| | - Björn Salomonsson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden.,Division of Orthopaedic Surgery, Danderyd hospital, Stockholm, Sweden
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Lateralized glenosphere reverse shoulder arthroplasty: inlay and onlay designs have similar clinical outcomes in patients with glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:747-754. [PMID: 34543744 DOI: 10.1016/j.jse.2021.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Whether or how the position of the humeral tray (inlay or onlay) in reverse shoulder arthroplasty (RSA) affects outcomes is unclear. Our goal was to compare the clinical and radiographic results of RSA systems with inlay vs. onlay designs but with similar neck shaft angles (NSAs) and lateralized glenospheres. METHODS We screened the institutional database at our tertiary academic center for patients who underwent primary RSA (with a lateralized glenosphere and a 135° NSA) from 2009 through 2017. The indication for surgery was glenohumeral osteoarthritis with glenoid bone loss (Walch classification A2, B2, B3, or C) and an intact rotator cuff. All patients were followed for a minimum of 2 years (mean, 47 months; range, 24-123 months). The humeral tray design was inlay for 79 patients and onlay for 71. All patients underwent preoperative and postoperative evaluations, including physical examination, radiography, and patient-reported outcome measures (visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Western Ontario Osteoarthritis of the Shoulder index). RESULTS Compared with preoperative values, both groups achieved minimal clinically important differences in range of motion and patient-reported outcomes at the final follow-up. We found no significant differences between groups in any of these measures at the final follow-up. Rates of revision (inlay, 3.8% vs. onlay, 1.4%), scapular notching (inlay, 5.1% vs. onlay, 7.0%), acromial stress fracture (inlay, 0% vs. onlay, 2.8%), and tuberosity resorption (inlay, 25% vs. onlay, 27%) were not significantly different between groups (all, P > .05). CONCLUSION For patients with glenohumeral osteoarthritis with glenoid bone loss and an intact rotator cuff who underwent RSA using a lateralized glenosphere prosthesis with a 135° NSA, there were no significant differences between the inlay and onlay groups for range of motion, patient-reported outcomes, or complication rates. These findings are limited to this off-label indication for RSA.
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Barandiaran AF, Houck DA, Schumacher AN, Seidl AJ, Frank RM, Vidal AF, Wolcott ML, McCarty EC, Bravman JT. Shoulder Surgery as an Effective Treatment for Shoulder-Related Sleep Disturbance: A Systematic Review. Arthroscopy 2022; 38:989-1000.e1. [PMID: 34478767 DOI: 10.1016/j.arthro.2021.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature in an effort to investigate sleep quality and disturbances and the association with clinical outcomes of patients undergoing shoulder surgery. METHODS A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to PRISMA guidelines. All English-language literature reporting clinical outcomes and sleep quality and disturbance after shoulder surgery was reviewed by 2 independent reviewers. Outcomes assessed included patient-reported outcomes (PROs) and sleep quality. Specific PROs included the Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) for pain, Simple Shoulder Test (SST), University of California Los Angeles (UCLA) Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Score (ASES). Study methodology was assessed using the Modified Coleman Methodology Score. Descriptive statistics are presented. RESULTS Sixteen studies (11 level IV, 2 level III, 3 level II) with a total of 2748 shoulders were included (age, 12-91 years; follow-up, 0.25-132 months). In total, 2198 shoulders underwent arthroscopic rotator cuff repair (RCR), 131 shoulders underwent arthroscopic capsular release, 372 shoulders underwent total shoulder arthroplasty (TSA), 18 shoulders underwent comprehensive arthroscopic management, and 29 shoulders underwent sternoclavicular joint procedures. All shoulder surgeries improved self-reported sleep and PROs from before to after surgery. In RCR patients, PSQI scores were significantly associated with VAS scores, SST scores (r = 0.453, r = -0.490, P < .05, respectively), but not significantly associated with UCLA Shoulder rating scale or the ASES scores (r = 0.04, r = 0.001, P > .05, respectively). In TSA patients, PSQI scores were significantly associated with ASES scores (r = -0.08, P < .05). All 4 RCR studies and 1 TSA study using PSQI found significant improvements in mean PSQI scores within 6 to 24 months (P < .05). CONCLUSIONS Surgical intervention for rotator cuff tear and glenohumeral osteoarthritis significantly improves self-reported sleep in patients with shoulder pain. However, there remains a dearth of available studies assessing the effects of surgical intervention for adhesive capsulitis, sternoclavicular joint instability, and sternoclavicular osteoarthritis on sleep. Future studies should use sleep-specific PROs and quantitative measures of sleep to further elucidate the relationship between sleep and the effect of shoulder surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Michelle L Wolcott
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
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Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10245773. [PMID: 34945069 PMCID: PMC8703579 DOI: 10.3390/jcm10245773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. Methods: This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior–posterior (AP) and superior–inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Results: Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (−19.4 ± 8.6° to −17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Conclusion: Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required.
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Baumgarten KM. The American Shoulder and Elbow Surgeons score has excellent correlation with the Western Ontario Osteoarthritis score. J Shoulder Elbow Surg 2021; 30:2604-2610. [PMID: 33895303 DOI: 10.1016/j.jse.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/04/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND/HYPOTHESIS The purpose of this study was to compare the correlation, responsiveness, and responder and administrator burden of the American Shoulder and Elbow Surgeons (ASES) score with the Western Ontario Osteoarthritis of the Shoulder (WOOS) score for patients undergoing total shoulder arthroplasty. The goal was to determine whether one score was superior to the other to limit the use of multiple scoring measures when tracking patient outcomes. The hypothesis of this study was that for patients undergoing total shoulder arthroplasty, the WOOS score would have (1) a high level of correlation with the ASES score, (2) comparable responsiveness to the ASES score, and (3) a higher responder and administrator burden than the ASES score. METHODS We performed a retrospective review of a database of patients undergoing total shoulder arthroplasty in which the ASES score was recorded with the WOOS score. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine whether correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations and by type of arthroplasty (anatomic vs. reverse). Responsiveness was determined by calculating the standardized response mean and the effect size of both scores. Responder and administrator burden was examined using 50 consecutive preoperative patients to determine the number of incorrectly completed WOOS and ASES scores. RESULTS The correlation of the ASES and WOOS scores for all patients was excellent (n = 1218, r = 0.88, P < .0001). The correlation of the ASES and WOOS scores was excellent for patients undergoing anatomic total shoulder arthroplasty (n = 695, r = 0.71, P < .0001) and reverse total shoulder arthroplasty (n = 523, r = 0.88, P < .0001). The correlation of preoperative scores was strong-moderate (n = 606, r = 0.62, P < .0001), and that of postoperative scores was strong-moderate (n = 612, r = 0.69, P < .0001). The standardized response mean (WOOS score, 2.1; ASES score, 2.1) and the effect size (WOOS score, 3.0; ASES score, 3.0) demonstrated comparable responsiveness. Twenty-six percent of the WOOS scores were completed incorrectly and were invalid compared with 0% of the ASES scores (P < .0001). CONCLUSION There is excellent correlation and comparable responsiveness between the ASES score and WOOS score. Including these scores simultaneously when tracking patient-determined outcomes appears to be redundant and therefore unnecessary. Because there is higher responder and administrative burden for the WOOS score, we recommend use of the ASES score over the WOOS score in patients undergoing total shoulder arthroplasty.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Dwyer T, Hoit G, Lee A, Watkins E, Henry P, Leroux T, Veillette C, Theodoropoulos J, Ogilvie-Harris D, Chahal J. Injection of Bone Marrow Aspirate for Glenohumeral Joint Osteoarthritis: A Pilot Randomized Control Trial. Arthrosc Sports Med Rehabil 2021; 3:e1431-e1440. [PMID: 34712981 PMCID: PMC8527259 DOI: 10.1016/j.asmr.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/13/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose To compare the efficacy of a single, intra-articular, nonconcentrated bone marrow aspirate (BMA) injection in comparison to cortisone for the treatment of glenohumeral joint osteoarthritis (GHJ OA). Methods Inclusion criteria were patients between the ages of 18 and 75 with a diagnosis of GHJ OA on radiograph. Patients were randomized to receive an ultrasound-guided, intra-articular cortisone injection or BMA injection (without concentration). The primary outcome measure was the Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 12 months. Secondary outcome measures were the QuickDASH, EuroQOL 5-dimensions 5-level questionnaire (EQ-5D-5L) and visual analogue scale. Results The study included 25 shoulders of 22 patients who completed baseline and 12 months’ patient-reported outcome measures (12 shoulders received cortisone, 13 shoulders received BMA) after the study was terminated early by changes in Health Canada regulations. Baseline characteristics demonstrated a significant difference in the ages of the 2 groups, with the BMA group being older (61.6 vs 53.8 mean years, P = 0.021). For the BMA group, a significant improvement was seen in the WOOS index (P = 0.002), the QuickDASH (P < 0.001), and the EQ-5D-5L pain dimension (P = 0.004) between baseline and 12 months. No significant difference was seen for any outcome in the cortisone group between baseline and 12 months. No significant difference was demonstrated between changes in the WOOS scores from baseline to 12 months when compared between groups (P = 0.07). However, a significant difference in changes in scores was seen in the QuickDASH (P = 0.006) and the EQ-5D-5L pain scores (P = 0.003) and the EQ-5D-5L health scores (P = 0.032) in favor of BMA. Conclusions The results of this study demonstrate that patients with GHJ OA treated with BMA have superior changes in the QuickDASH and EQ-5D-5L pain and health scores but not in the WOOS outcomes measures at 12 months post injection when compared to patients treated with cortisone. However, because of the limited number of patients as a result of the early termination of the study, larger randomized studies are required to confirm these findings. Level of Evidence Level II, randomized controlled trial.
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Affiliation(s)
- Tim Dwyer
- Women's College Hospital, Toronto, Ontario, Canada.,Mt Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Graeme Hoit
- University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Adrienne Lee
- University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Elyse Watkins
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Patrick Henry
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Tim Leroux
- Toronto Western Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Christian Veillette
- Toronto Western Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Women's College Hospital, Toronto, Ontario, Canada.,Mt Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Toronto Western Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
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Abstract
This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature. A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE. 506 studies were included in the final data analysis, for a total number of 36,553 patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency. A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed. A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs. Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109
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Affiliation(s)
- Roberto Padua
- Orthopedics Working Group on Evidence Based Medicine, GLOBE, Rome, Italy.,San Feliciano Group (Villa Aurora), Rome, Italy
| | - Laura de Girolamo
- Orthopaedics Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Germany
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Nyring MRK, Olsen BS, Amundsen A, Rasmussen JV. Minimal Clinically Important Differences (MCID) for the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and the Oxford Shoulder Score (OSS). PATIENT-RELATED OUTCOME MEASURES 2021; 12:299-306. [PMID: 34588833 PMCID: PMC8473013 DOI: 10.2147/prom.s316920] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022]
Abstract
Background The minimal clinically important difference (MCID) is an important instrument in the interpretation of changes in patient-reported outcome measures (PROM). To our knowledge, no MCID of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) score has ever been reported and no studies have reported an MCID for the Oxford Shoulder Score (OSS) based on patients with glenohumeral osteoarthritis, treated with an anatomical total shoulder arthroplasty (aTSA). The aim of this study was to determine MCID for WOOS and OSS in a cohort of patients with glenohumeral osteoarthritis treated with an aTSA. Methods All patients treated with an aTSA for glenohumeral osteoarthritis at our institution between March 2017 and February 2019 were included. Each patient completed the WOOS and the OSS preoperatively and one year postoperatively. At one year, the patients were asked to rate their overall improvement on a 7-point scale. We used an anchor-based method as our primary method to calculate the MCID, supported by two different distribution-based methods. Results A total of 45 primary aTSA were included. The MCID of WOOS was 12.3 according to the anchor-based method and 14.2 and 10.3 according to the two distribution-based methods. The MCID of OSS was 4.3 according to the anchor-based method and 5.8 and 4.3 according to the two distribution-based methods. Conclusion The anchor-based method is considered superior to the distribution-based method, and therefore we advocate to use this as MCID. For patients with glenohumeral osteoarthritis treated with an aTSA, the MCID values were 12.3 points for WOOS and 4.3 points for OSS. To our knowledge, this is the first study to report a MCID value for WOOS and the first study to report a MCID value for OSS in this subgroup of patients.
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Affiliation(s)
| | - Bo Sanderhoff Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, 2900, Denmark
| | - Alexander Amundsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, 2900, Denmark
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Xu W, Wu K, Roche S, Fu W, Huang L, Held MF, Guo JJ. Development and Validation of a Simplified Chinese Version and a Face-Scale Version of the Oxford Shoulder Score: A 2-Center Prospective Study. Orthop J Sports Med 2021; 9:23259671211023751. [PMID: 34568501 PMCID: PMC8461135 DOI: 10.1177/23259671211023751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
Background There has not yet been a pictorial version of a patient-reported outcome measure for shoulder pain. Purpose To translate the English version of the Oxford Shoulder Score (OSS) to a simplified Chinese version (SC-OSS) and to validate a new face-scale version of the OSS (FS-OSS), while investigating cross-cultural adaptation, validation, and reproducibility of both versions in patients with shoulder pain. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The translation and cross-cultural adaptation of the SC-OSS was performed using a forward-backward translation method. The FS-OSS was developed on the basis of the SC-OSS, using the Wong-Baker FACES Pain Rating Scale for reference. Participants were asked to complete the SC-OSS, FS-OSS, Simple Shoulder Test (SST), Constant-Murley score (CMS), and 36-Item Short Form Health Survey (SF-36). Validation and reproducibility were tested by calculating Cronbach α values for internal consistency as well as by intraclass correlation coefficients. Time needed to complete the scores was used to test cross-cultural adaption. Results A total of 312 respondents participated in the research and completed all outcome measures. The internal consistency was strong, with a Cronbach α of .94 and .91 for the FS-OSS and SC-OSS, respectively. High intraclass correlation coefficient values for the FS-OSS score (0.95) and SC-OSS (0.92) were obtained, which indicated excellent test-retest reliability. The Pearson correlation coefficients of the SC-OSS and FS-OSS with the SST (r = 0.67 and 0.65, respectively), CMS (r = 0.62 and 0.66, respectively), and SF-36 (r = 0.52 and 0.57, respectively) indicated good construct validity. The time needed to complete the FS-OSS was less than that needed for the SC-OSS and SST. Conclusion The FS-OSS and SC-OSS were validated as reliable instruments for patients with shoulder pain. For Chinese patients, the face-scale version was easier to understand than the cross-cultural text version.
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Affiliation(s)
- Wu Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Kailun Wu
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, PR China
| | - Stephen Roche
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lixin Huang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Michael F.G. Held
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, PR China
- Jiong Jiong Guo, MD, PhD, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, PR China ( or )
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Chin PYK, Regan WD, Plausinis D, Zarzour ZD, Leung F, Sasyniuk TM, Lim B, Sayre EC. Two-year results of a multi-centre, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed versus cemented polyethylene glenoid component in total shoulder arthroplasty. Bone Jt Open 2021; 2:728-736. [PMID: 34488426 PMCID: PMC8479846 DOI: 10.1302/2633-1462.29.bjo-2021-0073.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aims To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Methods Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed. Results A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted. Conclusion Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway. Cite this article: Bone Jt Open 2021;2(9):728–736.
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Affiliation(s)
| | | | | | - Zane D Zarzour
- The University of British Columbia, Vancouver, Canada.,The University of Victoria, Victoria, Canada
| | - Fay Leung
- The University of British Columbia, Vancouver, Canada
| | | | - Brendan Lim
- The University of British Columbia, Vancouver, Canada
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Nielsen KP, Amundsen A, Olsen BS, Rasmussen JV. Good long-term patient-reported outcome after shoulder arthroplasty for cuff tear arthropathy. JSES Int 2021; 6:40-43. [PMID: 35141674 PMCID: PMC8811402 DOI: 10.1016/j.jseint.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The use of the reverse shoulder arthroplasty (RSA) for cuff tear arthropathy (CTA) has increased within the last decades, but there is still limited information about the long-term outcome and how it performs in comparison with hemiarthroplasty (HA). The aim of this study was to compare the long-term patient-reported outcomes of RSA and HA for CTA. Methods We included all patients with CTA, who according to the Danish Shoulder Arthroplasty Registry, underwent either HA or RSA between 2006 and 2010. Patients who were alive were sent the Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire in 2020. One hundred twenty (65%) patients returned a complete questionnaire. The linear regression model was used to compare RSA and HA. Sex, age, and previous surgery were included in the multivariable model. Results Forty-two HAs and 78 RSAs were evaluated with a mean follow-up time of 11.5 and 10.6 years, respectively. The mean WOOS score was 66.7 for HA and 71.7 for RSA. The difference of 5.0 was neither statistically significant nor clinically important (95% confidence interval: -4.3 to 14.2, P = .17), nor were there any significant risk of a worse WOOS score for sex, age, or previous surgery. Conclusion To our knowledge, this is the first study to compare the long-term patient-reported outcomes of HA and RSA for CTA. Our results indicate that RSA is a reliable and durable treatment option for CTA with good long-term results. Based on this observational study, it is not possible to make safe estimates about the effect of RSA compared with HA, but similar to RSA, HA was associated with relatively good long-term results.
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Affiliation(s)
- Karoline P. Nielsen
- Corresponding author: Karoline P. Nielsen, MD, Friheds Alle 34, 6400 Sønderborg, Denmark.
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Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population. Health Qual Life Outcomes 2021; 19:174. [PMID: 34217326 PMCID: PMC8254980 DOI: 10.1186/s12955-021-01812-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background The main aim of post-mastectomy breast reconstruction is to improve the patient’s quality of life, which makes high-quality and validated patient-reported outcome measurements essential. None of the established instruments include evaluation of donor-site morbidity, such as impact on upper extremity and back function, when a latissimus dorsi (LD) muscle is used; and BREAST-Q LD questionnaire was therefore recently developed for this purpose. The aim of this study was to translate into Swedish and culturally adapt the BREAST-Q LD questionnaire’s two subscales, appearance and function, and perform a psychometric evaluation of the subscales in a Swedish population of patients. Methods This was a cross-sectional study. The questionnaire was translated according to established guidelines. The questionnaires were sent to all patients operated using an LD flap between 2007 and 2017. Internal consistency was assessed using Cronbach’s α. Inter-item correlations and corrected item-total correlations were calculated using the Pearson’s correlation coefficient. Convergent validity was evaluated by comparing the BREAST-Q LD questionnaire to the Western Ontario Osteoarthritis of the Shoulder Index, using the Spearman correlation coefficient. Test–retest reliability was tested with intraclass correlation coefficients (ICCs), and the coefficient of variation and Bland–Altman plots were drawn. Floor and ceiling effects were calculated. Known-group validation was tested by comparing scores from the patients and from normal controls using the Mann–Whitney U-test and by calculating eta squared effect size. Results The questionnaires were sent to 176 eligible patients and 125 responded (71%). The patients had been operated a mean of 6.6 years ago, and most (92%) had previous radiation. Internal consistency was satisfactory for both subscales. The correlation coefficients between questions were r > 0.30 for all items of both scales. The corrected item-total correlation coefficient ranged from 0.62 to 0.90. As hypothesised, the function scale was correlated with the WOOS “Physical symptoms” subscale. Reliability was adequate according to the ICCs. The ceiling effect threshold for the appearance scale was reached and that for the back scale was almost reached. There were significant differences between patients and controls, in the hypothesised direction. Conclusions The results of this study support a good internal consistency, convergent validity, test–retest reliability and known-group validation for the Swedish BREAST-Q LD questionnaire. However, it may be difficult to discriminate between patients with very mild and those with no symptoms using the appearance scale. Trial registration: ClinicalTrials.Gov identifier NCT04526561.
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Barger J, Zhang D, Stenquist DS, Ostergaard P, Hall M, Dyer GSM, Earp BE, von Keudell A. Correlation and responsiveness of global health, upper extremity-specific, and shoulder-specific functional outcome measures following reverse total shoulder arthroplasty for proximal humerus fracture. BMC Musculoskelet Disord 2021; 22:574. [PMID: 34162369 PMCID: PMC8223380 DOI: 10.1186/s12891-021-04450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reverse total shoulder arthroplasty (rTSA) is effective and increasingly utilized for the management of proximal humerus fracture (PHF). However, the optimal patient-reported outcome metrics (PROMs) for the evaluation of patient outcomes after this surgery are unclear. We investigated the correlation among global, upper extremity-specific, and shoulder-specific PROMs in patients undergoing rTSA for PHF as well as the responsiveness of these PROMs as assessed by floor and ceiling effects. We hypothesized that patients' post-operative outcome would be best reflected by a combination of these metrics. METHODS Thirty patients with a history of rTSA for ipsilateral PHF filled out the following outcomes questionnaires at a minimum of 3 years post-op: EQ-5D, EQ-5D VAS, PROMIS physical function, DASH, SSV, SPADI, and ASES. Correlation between metrics was assessed using the Spearman correlation coefficient. Responsiveness was assessed by comparing the proportion of patients reaching floor or ceiling values using McNemar's test. RESULTS Global health metrics (EQ-5D and PROMIS physical function) were strongly correlated with the upper extremity-specific metric (DASH). Shoulder-specific outcomes (SPADI, ASES, and ASES) were moderately correlated with both the global metrics and DASH. There was no significant difference between PROMs with regards to floor and ceiling effects. CONCLUSIONS The DASH score has been shown to be valid and responsive for shoulder interventions, and our data demonstrate that it correlates strongly with overall quality of life. Shoulder-specific metrics are valid and responsive for shoulder interventions but correlate less with global quality of life. An optimal PROM strategy in rTSA for PHF might involve both DASH and a shoulder-specific score. Based on our assessment of floor and ceiling effects, none of these metrics should be excluded for poor responsiveness.
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Affiliation(s)
- James Barger
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA. .,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA.
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Derek S Stenquist
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Peter Ostergaard
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Matthew Hall
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Arvind von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
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Özal Ş, Atalay Güzel N, Kaptan AY, Eren TK, Kafa N. Validity and Reliability of the Turkish Version of Western Ontario Osteoarthritis of the Shoulder Index. Jt Dis Relat Surg 2021; 32:497-503. [PMID: 34145829 PMCID: PMC8343853 DOI: 10.52312/jdrs.2021.141] [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] [Received: 04/07/2021] [Accepted: 05/07/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
This study aims to adapt the Western Ontario Osteoarthritis of the Shoulder (WOOS) index specific to shoulder osteoarthritis into Turkish and to evaluate its validity and reliability. Patients and methods
The WOOS index was translated and culturally adapted into Turkish, systematically. It was applied to a total of 68 patients (17 males, 51 females; mean age: 61.5±8.7 years; range, 45 to 80 years) with osteoarthritis of the shoulder treated conservatively. The reliability of the scale was checked through internal consistency and test-retest methods. Internal consistency was analyzed with Cronbach alpha value. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC) with 25 patients. The Western Ontario Rotator Cuff (WORC), the Shoulder Pain and Disability Index (SPADI), and the Society of American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) scores were used to conduct concurrent validity. Results
The Cronbach alpha value of the scale was found to be excellent as 0.92 (p<0.001). The ICC value was also excellent as 0.97 (p<0.001). There was an excellent positive correlation with WORC (0.847; p<0.001) and a very good positive correlation with SPADI (0.788; p<0.001). It was also negatively very good to correlate with the ASES (-0.754; p<0.001). Additionally, subsections of WOOS had a good correlation with the corresponding subsections of WORC (0.779-0.664; p<0.001). Conclusion
The Turkish version of the WOOS index is a valid and reliable tool and is recommended for use in the assessment of patients with osteoarthritis of the shoulder.
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Affiliation(s)
- Şeyda Özal
- Department of Physiotherapy and Rehabilitation, Gazi University, Faculty of Health Sciences, Ankara, Turkey
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Amundsen A, Brorson S, Olsen BS, Rasmussen JV. Ten-year follow-up of stemmed hemiarthroplasty for acute proximal humeral fractures. Bone Joint J 2021; 103-B:1063-1069. [PMID: 34058878 DOI: 10.1302/0301-620x.103b6.bjj-2020-1753.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome. METHODS We obtained data on 1,371 hemiarthroplasties for acute proximal humeral fractures from the Danish Shoulder Arthroplasty Registry between 2006 and 2010. Of these, 549 patients (40%) were alive and available for follow-up. The Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire was sent to all patients at nine to 14 years after primary surgery. Revision rates were calculated using the Kaplan-Meier method. Risk factors for an inferior WOOS score were analyzed using the linear regression model. RESULTS Mean age at surgery was 67 years (24 to 90) and 445 (81%) patients were female. A complete questionnaire was returned by 364 (66%) patients at a mean follow-up of 10.6 years (8.8 to 13.8). Mean WOOS score was 64 (4.3 to 100.0). There was no correlation between WOOS scores and age, sex, arthroplasty brand, or year of surgery. The 14-year cumulative revision rate was 5.7% (confidence interval 4.1 to 7.2). Patients aged younger than 55 years and patients aged between 55 to 74 years had 5.6-times (2.0 to 9.3) and 4.3-times (1.9 to 16.7) higher risk of revision than patients aged older than 75 years, respectively. CONCLUSION This is the largest long-term follow-up study of acute proximal humeral fractures treated with hemiarthroplasty. We found a low revision rate and an acceptable ten-year patient-reported outcome. The patient-reported outcome should be interpreted with caution as we have no information about the patients who died or did not return a complete WOOS score. The long-term outcome and revision rate suggest that hemiarthroplasty offers a valid alternative when non-surgical treatment is not possible. Cite this article: Bone Joint J 2021;103-B(6):1063-1069.
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Affiliation(s)
- Alexander Amundsen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Bo S Olsen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
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Aldon-Villegas R, Ridao-Fernández C, Torres-Enamorado D, Chamorro-Moriana G. How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures. Diagnostics (Basel) 2021; 11:845. [PMID: 34066777 PMCID: PMC8151204 DOI: 10.3390/diagnostics11050845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
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Affiliation(s)
- Rocio Aldon-Villegas
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Carmen Ridao-Fernández
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Dolores Torres-Enamorado
- Research Group “Women, Well-Being and Citizenship” SEJ066, Department of Nursing, University of Seville, 41930 Bormujos, Spain;
| | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
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