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Objective. To explore the physiometric and psychometric properties of clinical, generic, and condition-specific assessment instruments. To describe patients' outcome after total shoulder arthroplasty. Methods. Forty-three patients were assessed in a 5-6-year cross-sectional catamnesis. Results. With regard to shoulder joint stability, pain, general physical health, and mental health, the patients showed scores comparative to normative scores. Significant functional limitation was evidenced by low mean scores on the specific function scales (e.g., Disability of the Arm, Shoulder and Hand questionnaire score ‫؍‬ 64.0, normative score ‫؍‬ 86.6). There were high correlations among the joint-specific scales (up to 0.93) and moderate correlations between these and the generic and clinical scales. Factor analysis identified 3 different assessment domains. Conclusion. The patients' quality of life (QOL) was high and not affected by impairment in some specific functional abilities. Physical QOL, mental QOL, clinical assessment, condition-specific measures, and generic measures were identified as separate domains, all of which are required for a comprehensive and sophisticated assessment in practical clinical routine.

Objective. To assess the responsiveness (sensitivity to change) of 6 shoulder outcome instruments. Methods. In a prospective cohort study of 153 total shoulder arthroplasties, outcome was measured by the Short Form 36 (SF-36); Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH); Shoulder Pain and Disability Index (SPADI); American Shoulder and Elbow Surgeons questionnaire for the shoulder (ASES); and the Constant (Murley) Score (CS). Responsiveness was mainly quantified by effect sizes before and 6 months after operation. Sensitivity analysis of the effects by receiver operating characteristic (ROC) curves was performed to determine the instruments' ability to classify effects into global health change assessment categories. Results. Effect sizes of the self-assessment total scores were 0.71, 1.19, 2.10, and 2.13 for the SF-36, DASH, SPADI, and ASES, respectively. The clinical ASES and the CS had effect sizes of 1.87 and 2.23, respectively. The SPADI (effect size 2.12) and the CS (effect size 2.72) were most responsive for pain. For functioning, the patient ASES (effect size 2.10), the CS (effect size 1.82), and the clinical ASES (effect size 1.85) were almost equal. The SF-36 bodily pain scale and most scores of the condition-specific instruments showed a significant area under the ROC of up to 0.77. Conclusion. The SPADI and/or the CS are the most suitable for short, responsive, shoulder-specific assessment. The more expensive patient ASES can be used for most responsive shoulder-function assessment. For a comprehensive measurement of health and quality of life, the DASH and/or the SF-36 should be added to the set.

The German SPADI is a practicable, reliable and valid instrument, and can be recommended for the self-assessment of shoulder pain and function.

Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse shoulder prosthesis Delta III(®) were followed up postoperatively for a mean of 46 months including clinical and radiological examination. Complications were recorded and Constant score, DASH and SF36 were assessed. With the numbers given a significant reduction of pain was achieved from 8.7 to 3.0 (p < 0.001). There was a significant improvement of active flexion from 43° to 97° (p < 0.001) and active abduction from 44° to 90° (p < 0.001). However, at the same time, active external rotation with an adducted humerus decreased significantly from 26° to 12° (p = 0.012). The constant score improved significantly from 16.7 to 55.9 (p < 0.001). Sixteen patients (84%) rated their shoulder better or much better than before. In 43% an intraoperative and in 38% a postoperative complication occurred including two late stage infections which required prosthesis removal. Our results support the use of the reverse prosthesis as revision prosthesis. The reverse design helps to compensate functional deficits due to severe soft-tissue damage except active external rotation. Nevertheless, the revision is a technically demanding procedure reflected in a high rate of intraoperative complications. The rate of secondary infections of 10% remains a special concern.