Is Arm Dominance Associated With Clinically Meaningful Differences in Outcomes After Shoulder Arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Rehabilitation Medicine

Background:

• Evidence suggests dominant limb use may improve range of motion (ROM) after total shoulder arthroplasty (TSA).
• It remains unclear if achieving physical therapy milestones correlates with clinically meaningful patient-reported outcome measure (PROM) differences.

Purpose of the Study:

• Determine 12-month minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for SPADI, QuickDASH, NRS for pain, and Constant-Murley score.
• Investigate differences in achieving MCID or PASS between dominant- and nondominant-side TSAs at 12 months.

Main Methods:

• Retrospective analysis of 2152 primary anatomic or reverse TSA cases from a specialized orthopedic registry (2006-2024).
• PROMs (SPADI, QuickDASH, NRS, Constant-Murley) assessed at baseline and 12 months postoperatively.
• Distribution-based and sensitivity analyses using anchor-based MCIDs; adjusted logistic regression compared dominant vs. nondominant groups.

Main Results:

• No clinically important differences in MCID or PASS achievement between dominant and nondominant shoulders at 12 months.
• Approximately 25% of patients did not achieve QuickDASH MCID, and over 10% did not achieve pain MCID.
• Adjusted models showed no association between arm dominance and achieving MCID or PASS across PROMs.

Conclusions:

• Arm dominance is not a significant factor influencing MCID or PASS achievement after TSA.
• A substantial proportion of patients do not meet MCID or PASS thresholds post-TSA, irrespective of limb operated.
• Postoperative recovery expectations after TSA should not heavily rely on arm dominance as a determinant.