Parsons Moby, Routman Howard D, Roche Christopher P, Friedman Richard J
The Knee, Hip and Shoulder Center, Portsmouth, NH, USA.
Atlantis Orthopedics, Palm Beach, FL, USA.
JSES Open Access. 2019 Sep 13;3(3):174-178. doi: 10.1016/j.jses.2019.07.004. eCollection 2019 Oct.
The purpose of this study was to compare characteristics of patients who reported to be subjectively unimproved vs. improved after reverse total shoulder arthroplasty.
Data were derived from a prospective registry of patients who underwent reverse total shoulder arthroplasty with a minimum 2-year follow-up. Patients were asked to rate their subjective satisfaction and then divided into those who were unchanged or worse (unimproved group [UG]) vs. better or much better (improved group [IG]). The groups were compared for differences in demographic characteristics, preoperative factors, functional outcomes, and complications.
There were 1425 patients in the IG and 134 patients in the UG. Patients in the IG were more likely to have a diagnosis of osteoarthritis. Patients in the UG were more likely to have coronary artery disease and diabetes and to have undergone prior surgery. No differences in implant configuration were found between groups. Preoperative measures for patients in the UG were worse for pain and function but not for range of motion. The outcomes in patients in the UG were worse for all postoperative measures, as well as for preoperative-to-postoperative improvement. Of the patients in the UG, 48% continued to have moderate to severe pain postoperatively. The complication rate was significantly higher in the UG.
Up to 8.5% of patients rate themselves as unimproved after surgery. These patients are more likely to have certain comorbidities and to have undergone prior surgery. Although outcomes were significantly worse for all measures in the UG, improvement occurred in all measures despite patients subjectively being worse or unchanged. Residual pain and difficulty sleeping play a substantial role in subjective assessment of overall outcome.
本研究的目的是比较全肩关节置换术后主观感觉未改善与改善的患者的特征。
数据来自一个前瞻性登记系统，该系统纳入了接受全肩关节置换术且至少随访2年的患者。患者被要求对其主观满意度进行评分，然后分为无变化或更差（未改善组[UG]）与更好或好得多（改善组[IG]）。比较两组在人口统计学特征、术前因素、功能结果和并发症方面的差异。
改善组有1425例患者，未改善组有134例患者。改善组患者更有可能被诊断为骨关节炎。未改善组患者更有可能患有冠状动脉疾病和糖尿病，且曾接受过手术。两组之间在植入物配置方面未发现差异。未改善组患者术前的疼痛和功能指标较差，但活动范围指标不差。未改善组患者术后所有指标以及术前至术后的改善情况均较差。在未改善组患者中，48%术后仍有中度至重度疼痛。未改善组的并发症发生率显著更高。
高达8.5%的患者术后自评未改善。这些患者更有可能患有某些合并症，且曾接受过手术。尽管未改善组所有指标的结果明显更差，但所有指标均有改善，尽管患者主观感觉更差或无变化。残留疼痛和睡眠困难在总体结果的主观评估中起重要作用。
