- This study is the first to directly compare the trajectory of recovery after reverse total shoulder arthroplasty (RTSA), total shoulder arthroplasty (TSA), arthroscopic rotator cuff repair (ARCR) and arthroscopic biceps tenodesis (BT)
- At various time points, 309 patients reported their pain via visual analog scale, American Shoulder and Elbow Surgeons (ASES) score and Single Assessment Numeric Evaluation (SANE) score
- By 24 months, all groups showed significant improvement from baseline in pain, SANE score and ASES score; the TSA group showed the greatest total improvements on all three measures, even though that group was the oldest
- After TSA and RTSA, >80% of total pain reduction was achieved six weeks postoperatively, whereas after ARCR and BT, >80% of pain reduction was achieved only six months postoperatively
- The four groups were statistically similar in terms of pain reduction within six months and functional recovery within 12 months
Patients often undergo joint surgery with no clear understanding of their likelihood of having a good outcome or how long it will take to be pain-free and have better function. Therefore, they can't plan for a return to more normal activities and may feel frustrated about their rate of progress.
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Florian Grubhofer, MD, former shoulder & elbow fellow, and Jon J.P. Warner, MD, chief of the Shoulder Service and co-director of the Harvard Shoulder & Elbow Fellowship in the Department of Orthopaedics at Massachusetts General Hospital, and colleagues recently conducted the first study that directly compared the trajectory of recovery after the most common shoulder surgeries: reverse total shoulder arthroplasty (RTSA), total shoulder arthroplasty (TSA), arthroscopic rotator cuff repair (ARCR) and arthroscopic biceps tenodesis (BT).
The biggest surprise, they say in JSES International, was that TSA recovery was faster and less painful than recovery after arthroscopic BT or ARCR.
The researchers retrospectively reviewed the records of 309 patients who underwent RTSA (n=84, mean age 63); TSA (n=56, mean age 69); ARCR (n=40, mean age 58); or arthroscopic BT (n=129, mean age 55) between January 2013 and December 2017. Patients were included only if they completed the following at all time points:
- Pain score (visual analog scale)—preoperatively; after two, six and 12 weeks; and after six, 12 and 24 months
- American Shoulder and Elbow Surgeons (ASES) score, a measure of function—after six, 12 and 24 months
- Single Assessment Numeric Evaluation (SANE) score, rating of the operative and nonoperative shoulders—after six, 12 and 24 months
The speed of recovery was determined at each time point as a percentage of the outcome at 24 months.
Overall Change in Scores
By 24 months, all groups showed significant improvement from baseline in pain, SANE score and ASES score. The TSA group showed the greatest total improvements on all three measures.
Pain Recovery Rate
- TSA, 77% (P=0.03 vs. ARCR; P<0.001 vs. BT)
- RTSA, 68% (P=0.046 vs. BT)
- ARCR, 40%
- BT, 38%
- TSA, 90% (P=0.02 vs. ARCR; P<0.001 vs. BT)
- RTSA, 82% (P=0.04 vs. ARCR; P=0.03 vs. BT)
- ARCR, 58%
- BT, 57%
- TSA, 99% (P<0.001 vs. ARCR; P=0.009 vs. BT)
- RTSA, 88%
- ARCR, 73%
- BT, 78%
At six, 12 and 24 months, all groups had pain reduction >90%, without significant differences between groups.
- TSA, 96% (significantly higher than all other groups)
- RTSA, 85%
- ARCR, 76%
- BT, 77%
- TSA, 103% (significantly higher than all other groups)
- RTSA, 91%
- ARCR, 89%
- BT, 92%
- TSA, 92% (P=0.049 vs. BT)
- RTSA, 89%
- ARCR, 87%
- BT, 82%
At 12 months, all groups reached improvement ≥93%.
Patients sometimes get advice about their postoperative course from friends who may have had an entirely different procedure. The patient-derived findings of this study will equip clinicians for managing shoulder surgery patients' postoperative expectations.
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