Early post-operative predictors of 2-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 post-operative 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. Pre-operative Simple Shoulder Test (SST) scores, baseline characteristics, and post-operative 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 post-operative 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 < .018) and non-diabetic status (satisfied diabetics 2.1% vs. dissatisfied diabetics 8.3%, P = .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 post-operative 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% confidence interval 4.09-60.41, P < .001). At 6 months, a positive response to SST-2 was associated with a 6.2 times increased odds of satisfaction (95% confidence interval 3.42-11.06, P < .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 RnR arthroplasty.