Radiological outcome in reverse shoulder arthroplasty does not correlate with patient satisfaction or quality of life

While outcomes following reverse total shoulder arthroplasty (rTSA) have often been gauged through radiological assessments focusing on prosthesis position, there is increasing recognition of patient-reported outcomes, particularly satisfaction, as indicators of surgical success. The objective of this study was to correlate radiological findings with clinical outcomes, patient satisfaction, and health-related quality of life (HRQoL).

A retrospective evaluation was conducted on patients following rTSA at a minimum of 2 years postoperatively. Functional outcome (active range of motion [ROM], Constant Score [CS], American Shoulder and Elbow Surgeons score, and Simple Shoulder Test) and the Short Form-36 were evaluated. Strictly anteroposterior radiographs were used to determine preoperative and postoperative parameters. Preoperative measurements included acromiohumeral interval, reverse shoulder arthroplasty angle, center of rotation (COR), and deltoid length. Postoperatively, the lateralization angle, distalization angle, acromiohumeral distance, peg-glenoid rim distance, sphere-bone overhang distance, reverse shoulder arthroplasty, COR, and deltoid length were measured. Scapular notching was classified according to Sirveaux et al. RESULTS: A total of 49 patients were evaluated at an average of 30.78 ± 7.15 months postoperatively at last follow-up. Active ROM, pain on the Visual Analog Scale, and CS showed significant improvement (P < .05). There was a high level of patient contentment, which correlated positively with the American Shoulder and Elbow Surgeons score and CS, and negatively with postoperative pain Visual Analog Scale. Postoperative HRQoL, measured by the Short Form-36, showed strong positive correlations with all clinical scores (P < .05). Distalization had a negative impact on external rotation (P = .001) and strength capacity (P = .031). Medialization of the COR showed a contrary relationship to external rotation (P < .001) and strength capacity (P < .001).

This study confirms rTSA's effectiveness in reducing pain and improving daily function, with a high readiness among patients to undergo the surgery again. Patient contentment and HRQoL showed a strong correlation with the clinical outcomes of the surgery. Radiological measurements may predict postoperative ROM and scapular notching yet fail to accurately reflect patient quality of life.