Heldt Brett L, Lomax Justin L, Houston Harrison B, Griswold B Gage, Hao Kevin A, Barker Elizabeth P, Bozzone Anna E, Elwell Josie A, Parada Stephen A
Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Orthopedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Clin Shoulder Elb. 2025 Jun;28(2):204-212. doi: 10.5397/cise.2024.01067. Epub 2025 May 23.
The purpose of this study was to identify risk factors of pain while lying on the operative shoulder following primary reverse total shoulder arthroplasty (rTSA).
Patients who underwent primary rTSA with available (1-year) follow-up data were retrospectively identified. Demographics, diagnosis, comorbidities, implant configuration, surgical information, and pain scores (including preoperative, postoperative and improvement in pain) were assessed while lying on the operated shoulder. To categorize preoperative pain while lying on the operative shoulder, cohorts were defined based on above or below the average pain level. Postoperative pain and improvement in pain were defined based on the following thresholds: patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB). The PASS was defined as the 75th percentile of pain scores in patients with high satisfaction ratings after rTSA, while MCID and SCB were calculated as the difference in average pain improvement in patients with high versus low satisfaction rates postoperatively. Univariate and multivariate logistic regression analyses were conducted.
A total of 4,235 patients who underwent rTSA were included. Previous shoulder surgery, tobacco use, and preoperative pain lying on the operative shoulder failed to achieve threshold values. Subscapularis repair was associated with an improved ability to achieve the thresholds.
Tobacco use, higher preoperative pain levels, and previous shoulder surgery were negatively associated with satisfactory improvement in pain while lying on the postoperative shoulder. In contrast, subscapularis repair was associated with clinically significant improvements. Given that postoperative pain when lying on the operative side is a frequent preoperative question, understanding these influencing factors is useful when counseling patients on postoperative expectations. Level of evidence: III.
本研究的目的是确定初次反向全肩关节置换术（rTSA）后术侧肩部卧位时疼痛的危险因素。
回顾性纳入接受初次rTSA且有可用（1年）随访数据的患者。评估患者的人口统计学、诊断、合并症、植入物配置、手术信息以及术侧肩部卧位时的疼痛评分（包括术前、术后及疼痛改善情况）。为对术侧肩部卧位时的术前疼痛进行分类，根据疼痛水平高于或低于平均水平定义队列。术后疼痛及疼痛改善情况根据以下阈值定义：患者可接受症状状态（PASS）、最小临床重要差异（MCID）和显著临床获益（SCB）。PASS定义为rTSA后满意度高的患者疼痛评分的第75百分位数，而MCID和SCB计算为术后满意度高与低的患者平均疼痛改善的差值。进行单因素和多因素逻辑回归分析。
共纳入4235例行rTSA的患者。既往肩部手术、吸烟以及术侧肩部卧位时的术前疼痛未达到阈值。肩胛下肌修复与达到阈值的能力改善相关。
吸烟、术前疼痛水平较高以及既往肩部手术与术后肩部卧位时疼痛的满意改善呈负相关。相比之下，肩胛下肌修复与临床上的显著改善相关。鉴于术侧卧位时的术后疼痛是术前常见问题，了解这些影响因素有助于在向患者咨询术后预期时提供参考。证据级别：III级。
