Clinical outcomes validate the RAND/UCLA appropriateness criteria algorithm for anatomical total shoulder...

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Patient Outcomes

Background:

• The RAND Corporation at University of California, Los Angeles (RAND/UCLA) method was used to establish appropriateness criteria for anatomical total shoulder arthroplasty (aTSA).
• Patient-reported outcome measures (PROMs) are crucial for evaluating the success of orthopedic procedures like aTSA.
• Understanding how PROM variations correlate with the appropriateness of aTSA is essential for optimizing patient selection.

Purpose of the Study:

• To assess the relationship between the appropriateness of anatomical total shoulder arthroplasty (aTSA) and patient-reported outcome measures (PROMs).
• To determine if patient outcomes differ based on whether aTSA was deemed appropriate, inconclusive, or inappropriate.
• To clinically validate the RAND/UCLA aTSA appropriateness criteria algorithm.

Main Methods:

• A multicentre database identified 390 patients who underwent primary aTSA between November 2004 and January 2023.
• Patients were classified as appropriate (n=97), inconclusive (n=218), or inappropriate (n=75) using a modified RAND/UCLA appropriateness algorithm.
• Pre- and postoperative PROMs (including visual analogue scale and American Shoulder and Elbow Surgeons scores), minimal clinically important difference (MCID), substantial clinical benefit (SCB), and postoperative complications were analyzed.

Main Results:

• All patient groups demonstrated significant improvements in PROM scores postoperatively.
• Patients classified as 'appropriate' aTSA candidates showed significantly greater improvements in VAS and ASES scores compared to 'inconclusive' and 'inappropriate' groups.
• The 'appropriate' group had a higher proportion of patients achieving MCID (95.8%) and SCB (92.6%); no significant differences in postoperative complications were found across classifications.

Conclusions:

• The study clinically validates the RAND/UCLA aTSA appropriateness criteria, enabling more reliable patient selection.
• 'Appropriate' aTSA candidates were more likely to achieve MCID and SCB, suggesting better functional recovery.
• Failure to achieve SCB in 'appropriate' patients was often linked to postoperative complications, while in 'inappropriate' patients, it may relate to algorithm-accounted factors.