Tufts University School of Medicine, Boston, Massachusetts, USA.
New England Shoulder and Elbow Center, Boston, Massachusetts, USA.
Bone Joint J. 2024 Dec 1;106-B(12):1451-1460. doi: 10.1302/0301-620X.106B12.BJJ-2023-1459.R1.
A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness.
Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023. A total of 390 patients (mean follow-up 48.1 months (SD 42.0)) were included: 97 (24.9%) were classified as appropriate, 218 (55.9%) inconclusive, and 75 (19.2%) inappropriate. Patients were classified as "appropriate", "inconclusive", or "inappropriate", using a modified version of an appropriateness algorithm, which accounted for age, rotator cuff status, mobility, symptomatology, and Walch classification. Multiple pre- and postoperative scores were analyzed using Pearson's chi-squared test and one-way analysis of variance (ANOVA). Postoperative complications were also analyzed.
All groups achieved significant improvement in mean PROM scores postoperatively. "Appropriate" patients experienced significantly greater improvement in visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score compared to "inconclusive" and "inappropriate". The appropriate group had a significantly greater proportion of patients who achieved minimal clinically important difference (MCID) (95.8%; n = 93) and substantial clinical benefit (SCB) (92.6%; n = 89). Overall, 13 patients had postoperative complications. No significant differences in postoperative complications among classifications were found.
Our data clinically validate the RAND/UCLA aTSA appropriateness criteria algorithm, allowing for more rapid and reliable determination of aTSA candidacy. "Appropriate" patients were more likely to achieve MCID and SCB for ASES scores compared to "inappropriate" patients. Among "appropriate" patients who did not achieve SCB, 50% (n = 4) had a postoperative complication. There was a significantly higher proportion of postoperative complications among those who did not achieve SCB across all three groups. Only 7.1% (n = 1) of patients who did not achieve SCB in the inappropriate group had a postoperative complication. Thus, it can be inferred that the failure to reach SCB in the appropriate group was likely to be due to a postoperative complication, whereas for patients deemed "inappropriate", failure to reach SCB may be secondary to factors accounted for within our algorithm.
最近的一项研究使用加利福尼亚大学洛杉矶分校（UCLA）兰德公司（RAND）方法制定了解剖全肩关节置换术（aTSA）的适宜性标准。本研究的目的是确定患者报告的结果测量（PROM）如何根据适宜性而有所不同。
从多中心数据库中提取 2004 年 11 月至 2023 年 1 月期间接受初次 aTSA 的患者的临床数据。共纳入 390 例患者（平均随访 48.1 个月[42.0]）：97 例（24.9%）为适宜，218 例（55.9%）为不确定，75 例（19.2%）为不适宜。使用适当性算法的改良版本将患者分为“适当”、“不确定”或“不适宜”。适当性算法考虑了年龄、肩袖状况、活动能力、症状和 Walch 分类。使用 Pearson 卡方检验和单因素方差分析（ANOVA）分析了多种术前和术后评分。还分析了术后并发症。
所有组的 PROM 评分在术后均显著改善。与“不确定”和“不适宜”组相比，“适当”组的视觉模拟量表（VAS）和美国肩肘外科医师协会（ASES）评分的改善更为显著。适当组有更大比例的患者达到了最小临床重要差异（MCID）（95.8%；n=93）和明显临床获益（SCB）（92.6%；n=89）。总体而言，有 13 例患者发生了术后并发症。在分类中未发现术后并发症的显著差异。
我们的数据从临床角度验证了 RAND/UCLA aTSA 适宜性标准算法，能够更快速、更可靠地确定 aTSA 的适应证。与“不适宜”患者相比，“适当”患者更有可能达到 ASES 评分的 MCID 和 SCB。在未达到 SCB 的“适当”患者中，50%（n=4）有术后并发症。在所有三组中，未达到 SCB 的患者术后并发症比例显著更高。在不适宜组中，只有 7.1%（n=1）未达到 SCB 的患者发生了术后并发症。因此，可以推断出，在适当组中未达到 SCB 的原因可能是术后并发症，而对于被认为“不适宜”的患者，未达到 SCB 可能是由于我们算法中考虑的因素所致。
