Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2019 Jul;28(7):1217-1222. doi: 10.1016/j.jse.2018.12.008. Epub 2019 Mar 20.
The purpose of this study was to determine patients' preoperative expectations before primary elective reverse shoulder arthroplasty (RSA). We hypothesized that younger patients, patients with better preoperative function, patients with shoulder osteoarthritis (OA), and patients with no prior joint replacements would have higher expectations of RSA.
We prospectively studied 333 primary RSAs performed for cuff tear arthropathy (n = 242), OA (n = 68), or post-traumatic arthritis (n = 23). Expectations were assessed preoperatively using the Hospital for Special Surgery's shoulder surgery expectations survey. Preoperative patient-reported measures were assessed with the American Shoulder and Elbow Surgeons shoulder score; Shoulder Activity Scale score; Short Form 12 mental component and physical component scores; and visual analog scale scores for pain, fatigue, and general health. A Poisson regression model was performed to control for potential confounding variables.
Relief of night-time pain, relief of daytime pain, improvement in self-care, improvement in the ability to drive or put on a seat belt, and improvement in the ability to perform daily activities were reported as "very important" by approximately half of patients. No association was found between age and overall expectations. Multivariate analysis showed that better preoperative Shoulder Activity Scale and Short Form 12 physical component scores were associated with greater expectations (P < .001). OA was associated with greater expectations compared with cuff tear arthropathy (P < .001). A history of either contralateral RSA or any joint replacement was associated with lower expectations (P < .001).
Patients have the highest expectations for pain relief and the performance of simple tasks after RSA. Patients with higher preoperative function, OA, and no previous joint replacements have greater expectations of RSA.
本研究旨在确定初次择期反肩关节置换术（RSA）患者术前的期望。我们假设年轻患者、术前功能更好的患者、肩关节炎（OA）患者和无既往关节置换术的患者对 RSA 的期望更高。
我们前瞻性研究了 333 例因肩袖撕裂性关节炎（n = 242）、OA（n = 68）或创伤后关节炎（n = 23）行 RSA 的患者。术前使用美国特种外科医院肩关节手术期望调查量表评估期望。采用美国肩肘外科医师肩关节评分、肩关节活动量表评分、SF-12 心理成分和生理成分评分、视觉模拟评分评估术前患者报告的测量值，用于评估疼痛、疲劳和一般健康的夜间疼痛缓解、日间疼痛缓解、自我护理改善、驾驶或系安全带能力改善和日常活动能力改善。采用泊松回归模型控制潜在混杂变量。
约一半的患者将夜间疼痛缓解、日间疼痛缓解、自我护理改善、驾驶或系安全带能力改善以及日常活动能力改善评为“非常重要”。年龄与总体期望之间无相关性。多变量分析显示，术前肩关节活动量表和 SF-12 生理成分评分较好与期望较高相关（P <.001）。与肩袖撕裂性关节炎相比，OA 与更高的期望相关（P <.001）。对侧 RSA 或任何关节置换术的既往史与较低的期望相关（P <.001）。
患者对 RSA 后疼痛缓解和简单任务的执行有最高的期望。术前功能更好、OA 和无既往关节置换术的患者对 RSA 的期望更高。
