Berreta Rodrigo Saad, Khan Zeeshan A, Jan Kyleen, Villarreal-Espinosa Juan Bernardo, Rubin Jared, Lee Cadence, Harkin William, Scanaliato John P, Garrigues Grant E, Nicholson Gregory P, Cole Brian J, Verma Nikhil N
Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA.
University of Illinois College of Medicine, Chicago, IL, USA.
J Shoulder Elbow Surg. 2025 Apr 28. doi: 10.1016/j.jse.2025.03.022.
While prior studies have assessed the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) following reverse shoulder arthroplasty (rTSA) at 2-year follow-up, data on clinically significant outcomes at mid-term follow-up remain limited.
(1) To establish the MCID and PASS thresholds for rTSA with a minimum follow-up period of 5 years. (2) To examine factors that are predictive of MCID and PASS achievement for rTSA, including preoperative, demographic, and intraoperative variables.
All patients who underwent rTSA for rotator cuff arthropathy or glenohumeral arthritis from January 2016 to December 2018 were retrospectively identified through a prospectively-collected institutional database. MCID thresholds were determined by a distribution-based method while PASS thresholds were established using an anchor-based method. The patient reported outcome measures (PROMs) analyzed included American Shoulder and Elbow Surgeons (ASES) score and Single Assessment Numeric Evaluation (SANE) score and Veterans Rand (VR) 12. Multivariate logistic regressions were performed to determine factors associated with the achievement of MCID and PASS.
Eighty patients were included. The thresholds for MCID achievement and percentages that reached achievement were as follows: ASES, 11.4 (88.8%); SANE, 14.8 (85.0%); VR 12 Physical, 4.9 (66.3%). The thresholds for PASS achievement and percentages that reached achievement were as follows: ASES, 80.8 (65.0%); SANE, 75.9 (66.3%); VR 12 Physical, 44.4 (57.5%). Lower preoperative score was predictive of achieving MCID for all PROMs. Worker's compensation designation was predictive of failing to achieve MCID for ASES and MCID and PASS for SANE. A prior ipsilateral shoulder procedure was predictive of failing to achieve MCID for ASES, SANE, and VR 12 Physical. Tobacco use was predictive of failing to achieve MCID for VR 12 Physical.
This study defines the thresholds for MCID and PASS achievement at minimum 5-year follow-up in a cohort of patients undergoing rTSA for rotator cuff arthropathy or glenohumeral arthritis. More patients achieved MCID than PASS for all PROMs, and lower preoperative scores were predictive of the achievement of MCID. Additionally, factors such as worker's compensation designation, prior surgical history of the ipsilateral shoulder, and tobacco use were found to be predictive of failing to achieve MCID and PASS at mid-term follow-up.
虽然先前的研究已经评估了反向肩关节置换术（rTSA）术后2年随访时的最小临床重要差异（MCID）和患者可接受症状状态（PASS），但中期随访时临床显著结果的数据仍然有限。
（1）确定随访期至少为5年的rTSA的MCID和PASS阈值。（2）研究预测rTSA达到MCID和PASS的因素，包括术前、人口统计学和术中变量。
通过前瞻性收集的机构数据库，回顾性确定2016年1月至2018年12月期间因肩袖关节病或盂肱关节炎接受rTSA的所有患者。MCID阈值采用基于分布的方法确定，而PASS阈值采用基于锚定的方法确定。分析的患者报告结局指标（PROMs）包括美国肩肘外科医师（ASES）评分、单项评估数字评定（SANE）评分和退伍军人兰德（VR）12量表。进行多因素逻辑回归分析以确定与达到MCID和PASS相关的因素。
纳入80例患者。达到MCID的阈值及达到该阈值的百分比如下：ASES评分，11.4（88.8%）；SANE评分，14.8（85.0%）；VR 12量表身体功能部分，4.9（66.3%）。达到PASS的阈值及达到该阈值的百分比如下：ASES评分，80.8（65.0%）；SANE评分，75.9（66.3%）；VR 12量表身体功能部分，44.4（57.5%）。术前较低的评分可预测所有PROMs达到MCID。工伤赔偿认定可预测ASES评分未达到MCID以及SANE评分未达到MCID和PASS。同侧肩部既往手术可预测ASES评分、SANE评分和VR 12量表身体功能部分未达到MCID。吸烟可预测VR 12量表身体功能部分未达到MCID。
本研究定义了一组因肩袖关节病或盂肱关节炎接受rTSA的患者在至少5年随访时达到MCID和PASS的阈值。所有PROMs中，达到MCID的患者比达到PASS的患者更多，术前较低的评分可预测达到MCID。此外，发现工伤赔偿认定、同侧肩部既往手术史和吸烟等因素可预测在中期随访时未达到MCID和PASS。
