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Quantifying success after total shoulder arthroplasty: the minimal clinically important difference.

Ryan Simovitch1, Pierre-Henri Flurin2, Thomas Wright3

  • 1Palm Beach Orthopaedic Institute, Palm Beach Gardens, FL, USA.

Journal of Shoulder and Elbow Surgery
|November 23, 2017
PubMed
Summary

The minimal clinically important difference (MCID) after total shoulder arthroplasty (TSA) is nominal and achieved by most patients. Female gender and reverse TSA (rTSA) were associated with lower MCID values compared to male gender and anatomic TSA (aTSA).

Keywords:
MCIDMinimal clinically important differenceanatomic total shoulder arthroplastyreverse total shoulder arthroplastyshoulder arthroplastyshoulder replacement

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Area of Science:

  • Orthopedics
  • Reconstructive Surgery
  • Patient Outcomes Research

Background:

  • Establishing the minimal clinically important difference (MCID) for shoulder outcome metrics is crucial for defining successful total shoulder arthroplasty (TSA).
  • MCID can vary based on prosthesis type, patient demographics, and follow-up duration.
  • This study quantifies these variations in MCID after TSA.

Purpose of the Study:

  • To determine the MCID for various shoulder outcome measures and range of motion after TSA.
  • To analyze how MCID differs between anatomic TSA (aTSA) and reverse TSA (rTSA).
  • To investigate the influence of patient age, gender, and follow-up length on MCID.

Main Methods:

  • A cohort of 466 patients undergoing aTSA or rTSA with a minimum 2-year follow-up was analyzed.
  • Anchor-based methods were used to calculate MCID for multiple patient-reported outcome measures and active range of motion.
  • Data were stratified by prosthesis type, gender, and age.

Main Results:

  • MCID values were calculated for the American Shoulder and Elbow Surgeons score (13.6), Constant score (5.7), UCLA score (8.7), SST (1.5), SPADI (20.6), global function (1.4), VAS pain (1.6), active abduction (7°), forward flexion (12°), and external rotation (3°).
  • Female patients and those receiving rTSA demonstrated lower MCID values compared to male patients and aTSA recipients.
  • These findings provide specific thresholds for meaningful improvement after different types of TSA.

Conclusions:

  • The MCID after TSA is generally nominal and achieved by at least 80% of patients.
  • Lower MCID values in females and rTSA patients suggest potential differences in perceived improvement thresholds.
  • Future research should explore the impact of different anchor questions on MCID calculations.