Early Postoperative Predictors of Two-Year Satisfaction after Ream and Run Arthroplasty

Treatment of glenohumeral arthritis in the young, active patient is challenging. The ream-and-run (RnR) arthroplasty allows for unrestricted activity but in some patients can include difficult and longer post-operative rehabilitation and a higher early revision rate. Improvement can occur up to 2 years after surgery, but counseling on expectations in the early postoperative period is uncertain. The objective of this study was to determine if shoulder pain at rest and with sleep in the early post-operative period were predictive of satisfaction at 2 years post-operatively.

This study included 375 patients from a longitudinally maintained shoulder arthroplasty database who underwent RnR with minimum 2-year follow-up. Preoperative Simple Shoulder Test (SST) scores, baseline characteristics, and postoperative SST scores were collected at regular intervals. Satisfaction was assessed at 24 months. We specifically examined responses to the SST Questions 1 (SST-1) and 2 (SST-2): "is your shoulder comfortable at rest?" and "does your shoulder allow you to sleep comfortably at night?" at 3 and 6 months postoperative in patients who were or were not satisfied at 24 months. Positive and negative predictive values (PPV and NPV) were calculated. A multivariate binomial logistic regression was performed to control for age, sex, prior surgery, and baseline SST to determine whether patient responses of SST-1 and SST-2 at 3 and 6 months were associated with 2-year satisfaction.

Male sex (satisfied 96.6% vs. dissatisfied 84.5%, p<0.018) and nondiabetic status (satisfied diabetics 2.1% vs dissatisfied diabetics 8.3%, p=0.036) were patient factors associated with 2-year satisfaction. The PPV of SST-1 was nearly 80% at every time point, and the NPV of SST-1 reached 80% at 3 months and 1 year. The PPV of SST-2 was greater than 80% at every postoperative time point, while the NPV rose to 50.6% at 6 months and 63.6% at 12 months. From the multivariable analysis at 3 months, a positive response to SST-1 was associated with a 15.7 times increased odds of 2-year satisfaction (95% CI 4.09-60.41, p<0.001). At 6 months, a positive response to SST-2 was associated with a 6.2 times increased odds of satisfaction (95% CI 3.42-11.06, p<0.001).

Shoulder comfort at rest at 3 months and shoulder comfort during sleep at 6 months are independent predictors of 2-year satisfaction after RnR. These data can be considered in determining prognosis for patients in the early recovery after ream and run arthroplasty.

Level IV, Case Series, Prognosis Study.