Postoperative patient-reported outcomes and radiographic findings do not significantly change between 1 and 2 years postoperatively after primary anatomic shoulder arthroplasty

Abstract

Background: It is unclear if there are significant changes in clinical and radiographic outcomes between 1 and 2 years postoperatively after total shoulder arthroplasty (TSA). The current multicenter study sought to compare patient-reported outcome measures (PROMs), range of motion, and radiographic analysis of glenoid and humeral loosening between 1 and 2-years postoperatively in a cohort of patients after primary anatomic TSA (aTSA).

Methods: A retrospective cohort of patients who underwent primary aTSA between 2017 and 2018 at 2 high-volume shoulder arthroplasty centers and had baseline, 1 and 2-year PROMs were included in the study. The American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numerical Evaluation scores were collected. Radiographs were evaluated at 1- and 2- years for humeral calcar resorption and glenoid component radiolucent lines and osteolysis.

Results: Two hundred eleven patients were included. Median preoperative version was -5° [IQR -8; -2] and inclination was 6° [IQR 4; 9]. There was no statistically significant difference between 1 and 2-years total ASES score (92.6 [IQR 86.7; 97.9] vs. 95 [IQR 85; 98.3], P = .71), ASES pain sub-score (50 [IQR 45; 50] vs. 50 [IQR 45; 50], P = .05), Single Assessment Numerical Evaluation score (90 [IQR 83.5; 98] vs. 93 [IQR 85; 98.3], P = .60) and external rotation (55° [IQR 50; 60] vs. 60° [IQR 50; 60], P = .66). There was a statistically significant difference in the ASES function sub-score (43.3 [IQR 38.9; 48.2] vs. 46.3 [IQR 41.2; 48.3], P = .03, respectively), and forward elevation (150° [IQR 135; 160] vs. 155° [IQR 143.8; 165], P = .002). One hundred forty-five of 211 (69%) patients had complete radiographic data. There was no statistically significant difference in the incidence of glenoid component osteolysis (3.4% vs. 5.4%, P = .25), radiolucent lines (36.1% vs. 29.9%, P = .15), or humeral calcar resorption (58.5% vs. 49.7%, P = .06) between 1 and 2 years. There were 2 (0.9%) complications in the cohort, both of which occurred within the first 12 months postoperatively.

Conclusion: The present study demonstrates no changes in most PROMs and all measured radiographic findings between 1 and 2-years postoperatively after primary aTSA. This data can help drive clinical decision-making with regard to the need for visits at both 1 and 2 years postoperatively for the collection of PROMs, which add cost for the health care system and patients. Additionally, this may support lowering the minimum threshold required for reporting of "short term" follow-up in clinical research for aTSA.

Keywords: Patient-reported outcomes; anatomic total shoulder arthroplasty; glenoid osteolysis; glenoid radiolucent line; humeral calcar resorption; total shoulder arthroplasty; value-based care.