What Factors are Associated With Clinically Important Improvement After Shoulder Hemiarthroplasty for Cuff Tear Arthropathy?

Abstract

Background In selected patients with a desire to maintain activity levels greater than those recommended after reverse total shoulder arthroplasty, hemiarthroplasty remains an option for treatment of cuff tear arthropathy (CTA). However, given the relatively small case series that have been reported to date, little is known regarding which patients will show functional improvement after this surgery.Questions/purposes We asked: What factors are associated with achieving the minimum clinically important difference in the simple shoulder test (SST) after hemiarthroplasty for cuff tear arthropathy? Patients and Methods Between 1991 and 2007, two surgeons at one academic center performed 48 shoulder hemiarthroplasties for CTA. No patients were known to have died before data collection, and of those not known to have died, 42 (88%) were available for followup at a mean of 48 months (range, 24-132 months). During that time, the general indications for this approach were glenohumeral arthritis with superior decentering of the humeral head. The majority of the patients with CTA were treated nonoperatively with patient-directed physical therapy and other modalities. A total of 42 patients (42 shoulders; 24 males and 18 females) with CTA were treated with hemiarthroplasty and followed for a mean of 48 months (range, 24-132 months). This is a retrospective study that made use of a longitudinally maintained database, which included physical examination of ROM, the SST, VAS, and standardized radiographs. At latest followup, 33 of 42 patients achieved a clinically important percentage of maximum possible improvement (%MPI) in SST score, One of the authors certifies that he (KB), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from DepuySynthes (Warsaw, IN, USA). One of the authors certifies that he (CAR), has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Depuy-Synthes (Warsaw, IN, USA). One of the authors certifies that he (MAW), has or may receive payments or benefits, during the study period, an amount of USD 100,001-1,000,000 from Depuy-Synthes (Warsaw, IN, USA) and less than USD 10,000 from Tornier (Lyon, France), Saunders (Philadelphia, PA, USA) and Arthrex (Naples, FL, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained....

Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty?

“…Roy et al [42] suggested that the minimal clinically important difference for the SST in shoulder arthroplasty is 3. Others have suggested that the minimal clinically important difference is 30% of the MPI from preoperative to latest followup [11,31,48].…”

“…Hsu et al [22] reported an extensive validation for the use of the SST in patients having shoulder arthroplasty. From the results of clinic visits and from routinely mailed followup questionnaires documented in a longitudinally maintained database, we recorded the preoperative SST, 2-year postoperative SST, preoperative to postoperative change in SST, percent of maximum possible improvement (%MPI) in the SST calculated as: (followup SST score À preoperative score)*100% / (12 À preoperative score) [11,31,48], and any history of postoperative dislocation or subluxation.…”

“…Standardized preoperative and postoperative radiographs included AP and axillary lateral views [17][18][19]48]. Adequate observation of the spinoglenoid notch confirmed proper orientation of the axillary view [19,29].…”

The modern use of the extended humeral head (cuff tear arthropathy) hemiarthroplasty

“…Improvements in functional scores and range of motion were also observed, with a 95% patient satisfaction rate at an average follow-up of 20 months. Somerson et al 38 evaluated a mixed cohort of traditional and CTA hemiarthroplasty prostheses and reported that patients with an intact teres minor, intact subscapularis, and lower preoperative external rotation had a better prognosis for achieving clinical improvement after hemiarthroplasty.…”

Evaluating the Minimal Clinically Important Difference of EQ-5D-3L in Patients With Degenerative Lumbar Spinal Stenosis

“…When applying these MCID thresholds in future studies, researchers should take care that these thresholds are always an average estimate and that individual patients may have greater or lower thresholds for perceiving an important change. Given the risk of ceiling effects in EQ-5D-3L, it might be more appropriate to use a relative measure of improvement, such as the percentage of possible improvement (PPI) following Gilmer et al 47 and Somerson et al 48 in addition to the change score.…”