Defining the tipping point for primary shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Patient-Reported Outcomes Research

Background:

• Limited objective criteria exist to guide surgeons on optimal timing for shoulder arthroplasty.
• Understanding patient-reported outcome measures (PROMs) tipping points is crucial for surgical decision-making.

Purpose of the Study:

• To characterize tipping-point scores for PROMs in patients undergoing primary shoulder arthroplasty.
• To identify factors influencing these tipping points.

Main Methods:

• Retrospective review of 5670 primary shoulder arthroplasties (anatomic and reverse shoulder arthroplasties [RSAs]).
• Evaluation of preoperative range of motion, PROMs (American Shoulder and Elbow Surgeons, Simple Shoulder Test, Shoulder Pain and Disability Index), and Constant scores.
• Univariate and multivariate analyses to assess risk factors for lower tipping points.

Main Results:

• Patients undergoing RSA showed lower tipping points across range-of-motion and multiple PROM scores.
• Female sex was a predictor of lower tipping points for both anatomic and reverse shoulder arthroplasty.
• Higher body mass index was also associated with lower tipping points in the anatomic total shoulder arthroplasty subgroup.

Conclusions:

• Shoulder arthroplasty timing is influenced by physical and social factors.
• Female patients and those receiving RSAs are more likely to proceed with surgery at a point of slightly diminished shoulder function.