Search

Background: The purpose of this study was to compare patient-reported outcomes (PROs) and range of motion (ROM) measurements between patients achieving and failing to achieve a Patient Acceptable Symptom State (PASS) after anatomic total shoulder arthroplasty (TSA) to determine which PRO questions and ROM measurements were the primary drivers of poor outcomes. Methods: A retrospective review of a multicenter database identified 301 patients who had undergone primary TSA between 2015 and 2018 with ROM and PRO data recorded preoperatively and at a minimum of two years postoperatively. The primary outcome was the difference in active ROM between patients achieving and failing to achieve the PASS threshold for the American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. The secondary outcome was the difference in self-reported pain levels between those achieving and failing to achieve a PASS. Results: Based on the ASES PASS threshold, 87% (261/301) of patients achieved a PASS after TSA, whereas 13% did not. Based on the SANE PASS threshold, 69% (208/301) of patients achieved a PASS after TSA, whereas 31% did not. Patients who failed to achieve a PASS after TSA were younger and had lower short form-12 mental health scores than those who did. There was a significant difference in pain between those who achieved and failed to achieve a PASS after TSA (ASES PASS current shoulder pain 16.5% vs. 95%, P

Background: Stress shielding of the humeral stem is a known complication in press-fit total shoulder arthroplasty (TSA), but there remain limited data on its prevalence and clinical impact in midterm follow-up. The purpose of this study was to determine the prevalence of humeral stem stress shielding and its impact on functional outcomes at minimum 5-year follow-up in standard length press-fit TSA. The hypothesis was that the presence of stress shielding at minimum 5-year follow-up would not affect functional outcome scores or range of motion (ROM). Methods: A multicenter retrospective review of primary TSAs performed with a press-fit standard length humeral stem. Functional outcome scores, ROM, and radiographs were reviewed at minimum 5-year follow-up. Prevalence of stress shielding was determined by presence of medial calcar osteolysis and adaptive changes. Function was assessed with the visual analog scale (VAS) pain score, Simple Shoulder Test (SST) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and Single Assessment Numeric Evaluation (SANE) score, and ROM. Results: Forty-seven patients with 47 TSAs were available for follow-up at a mean of 79 months postoperation. Overall, 15 of 47 humeral stems had high adaptive change scores (31.9%), and 20 demonstrated medial calcar osteolysis (42.6%). Stems with evidence of stress shielding showed no significant change in SST, VAS, ASES, or SANE scores and minimal change in ROM measurements at minimum 5-year follow-up. Conclusion: Stress shielding is common at midterm follow-up in press-fit TSA but does not appear to affect functional outcomes.