Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
J Shoulder Elbow Surg. 2018 Nov;27(11):1987-1995. doi: 10.1016/j.jse.2018.03.028. Epub 2018 May 24.
Total shoulder arthroplasty (TSA) decreases pain, improves range of motion, and increases strength. Whether these improvements translate to improvements in activity levels postoperatively remains unknown. The Shoulder Activity Level (SAL) is a valid and reliable outcomes survey that measures the patient's activity level. Currently, no studies have specifically examined the effect of TSA on SAL.
A prospective collection of preoperative, patient-determined outcomes on patients undergoing TSA was compared with postoperative scores at a minimum of 2 years. These scores included the SAL, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment, Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST). Inclusion criteria were patients undergoing primary anatomic TSA or reverse TSA.
A mean follow-up of 3.7 years was available for 80 anatomic and 42 reverse TSAs. Anatomic TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (34 to 89; P < .0001), ASES (30 to 87; P < .0001), SST (2 to 9; P < .0001), and SANE scores (23 to 90; P < .0001). The SAL improved from 7 to 8 but did not quite reach statistical significance (P = .07). Reverse TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (31 to 83; P < .0001), ASES (29 to 82; P < .0001), SST (2 to 7; P < .0001), and SANE scores (20 to 85; P < .0001). The SAL improved from 4.5 to 6, but this did not reach statistical significance (P = .38). However, when anatomic and reverse TSAs were analyzed together, a statistically significant improvement was found postoperatively in the SAL (from 6 to 8; P = .006).
Anatomic TSA and reverse TSA improved activity levels. In addition, disease-specific and joint-specific quality of life scores all had statistically significant improvements. This study suggests that after shoulder arthroplasty patients in general have (1) significant improvements in their quality of life and (2) have small improvements in activity level. This study shows that most patients do not have to decrease their activity levels to diminish symptoms to an acceptable range.
全肩关节置换术（TSA）可减轻疼痛、改善活动范围并增强力量。这些改善是否能转化为术后活动水平的提高尚不清楚。肩关节活动水平（SAL）是一种有效的、可靠的测量患者活动水平的结果调查。目前，尚无专门研究 TSA 对 SAL 的影响的研究。
前瞻性收集行 TSA 患者的术前、患者确定的结果，并与至少 2 年的术后评分进行比较。这些评分包括 SAL、西部安大略省肩关节炎指数（WOOS）、美国肩肘外科医生（ASES）标准化肩部评估、单一评估数字评估（SANE）和简单肩部测试（SST）。纳入标准为接受原发性解剖 TSA 或反向 TSA 的患者。
80 例解剖 TSA 和 42 例反向 TSA 可获得平均 3.7 年的随访。解剖 TSA 的 WOOS（从 34 分升至 89 分；P<0.0001）、ASES（从 30 分升至 87 分；P<0.0001）、SST（从 2 分升至 9 分；P<0.0001）和 SANE 评分（从 23 分升至 90 分）均有改善。SAL 从 7 分提高到 8 分，但未达到统计学意义（P=0.07）。反向 TSA 的 WOOS（从 31 分升至 83 分；P<0.0001）、ASES（从 29 分升至 82 分；P<0.0001）、SST（从 2 分升至 7 分；P<0.0001）和 SANE 评分（从 20 分升至 85 分）均有改善。SAL 从 4.5 分提高到 6 分，但未达到统计学意义（P=0.38）。然而，当将解剖 TSA 和反向 TSA 一起分析时，SAL 术后有统计学意义的改善（从 6 分升至 8 分；P=0.006）。
解剖 TSA 和反向 TSA 可提高活动水平。此外，特定于疾病和特定于关节的生活质量评分均有显著改善。本研究表明，一般情况下，肩部置换术后患者（1）生活质量有显著改善，（2）活动水平有小幅度提高。本研究表明，大多数患者不必降低活动水平，即可将症状减轻到可接受的范围。
