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Is There an Association Between Postoperative Internal Rotation and Patient-reported Outcomes After Total Shoulder

Reme Arhewoh1, J Ryan Hill, Julianne Sefko

  • 1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Clinical Orthopaedics and Related Research
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Postoperative internal rotation is crucial for acceptable outcomes after shoulder arthroplasty (TSA). Achieving internal rotation to the midback or higher is associated with better results, highlighting the importance of addressing deficits.

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Rehabilitation medicine

Background:

  • Limited internal rotation after shoulder arthroplasty (TSA) can significantly impair daily activities requiring behind-the-back arm positioning.
  • While postoperative internal rotation deficits are observed, their precise impact on TSA outcomes remains unclear.
  • The Single Assessment Numeric Evaluation (SANE) is a validated patient-reported outcome measure for TSA success.

Purpose of the Study:

  • To determine the association between postoperative internal rotation and acceptable TSA outcomes, as measured by SANE scores.
  • To identify a potential threshold for internal rotation beyond which further gains do not significantly improve the likelihood of acceptable outcomes.

Main Methods:

  • A retrospective analysis of 784 patients undergoing primary anatomic or reverse TSA (RTSA) using a single-institution registry.
  • Logistic multivariate analysis assessed the association between internal rotation and SANE scores (>75%).
  • Receiver operating characteristic (ROC) curve analysis identified the internal rotation threshold for acceptable outcomes.

Main Results:

  • Patients with internal rotation below the upper back had significantly lower odds of achieving a SANE score >75% (p < 0.05).
  • The threshold for acceptable outcomes (SANE >75%) was identified as internal rotation to the midback or higher (AUC = 0.71).
  • The identified threshold demonstrated 57% sensitivity and 75% specificity for predicting acceptable outcomes.

Conclusions:

  • Postoperative internal rotation is associated with overall shoulder normalcy and acceptable outcomes after TSA.
  • While causality is not proven, limited internal rotation appears clinically significant, particularly for RTSA.
  • Addressing postoperative internal rotation deficits may enhance the quality of shoulder arthroplasty outcomes; further research into modifiable factors is warranted.