Patient-reported outcomes following total shoulder arthroplasty and hemiarthroplasty: an analysis of data from the National Joint Registry

Andrew R Davies; Sanjeeve Sabharwal; Alexander D Liddle; Bernarda Zamora-Talaya; Amar Rangan; Peter Reilly

doi:10.1016/j.jse.2024.01.053

Patient-reported outcomes following total shoulder arthroplasty and hemiarthroplasty: an analysis of data from the National Joint Registry

J Shoulder Elbow Surg. 2024 Nov;33(11):2411-2420. doi: 10.1016/j.jse.2024.01.053. Epub 2024 Mar 22.

Authors

Andrew R Davies¹, Sanjeeve Sabharwal², Alexander D Liddle³, Bernarda Zamora-Talaya⁴, Amar Rangan⁵, Peter Reilly⁶

Affiliations

¹ Department of Bioengineering, Imperial College London, London, UK. Electronic address: a.davies20@imperial.ac.uk.
² Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK.
³ Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK.
⁴ Department of Surgery and Cancer, Imperial College London, London, UK.
⁵ Department of Health Sciences, University of York, York, UK.
⁶ Department of Bioengineering, Imperial College London, London, UK; Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK.

PMID: 38522778
DOI: 10.1016/j.jse.2024.01.053

Abstract

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of end-stage glenohumeral arthritis. Improvement in shoulder function and resolution of symptoms are high priorities for patients. The aim of this study was to compare patient-reported outcome measures (PROMs) following TSA and HA.

Methods: Records from the National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man were linked to the PROMs data set. The study included anatomic shoulder arthroplasties performed for osteoarthritis in patients with an intact rotator cuff. Patients with preoperative and postoperative Oxford Shoulder Scores (OSSs) were included. The improvement in OSS at 6 months and 5 years and the trend in scores over time were analyzed for each prosthesis. A cohort of 2002 patients were matched on 10 variables using propensity scores. OSSs at 6 months following TSA vs. HA were compared in the matched sample.

Results: There was a significant improvement in the OSS in both groups (P < .001). At 6 months, the OSSs were superior following TSA compared with HA (median 42 vs. 36, P < .001). The median score at 5 years was 44 following TSA and 35 following HA. Score distributions were skewed toward the maximum score. The highest possible score (48) was achieved in 28% (134 of 478) of TSAs and 9% (20 of 235) of HAs at 5 years. The improvement in the preoperative to 6-month OSS reached the minimal clinically important difference of 5.5 in 92% (1653 of 1792) of TSAs and in 80% (416 of 523) of HAs. At 5 years, this improvement was maintained in 91% (339 of 374) of TSAs and 78% (136 of 174) of HAs.

Conclusion: TSA resulted in superior OSSs at 6 months in patients with osteoarthritis. The median OSS improved from 6 months to 5 years following TSA; however, there was a small decline in scores following HA. A ceiling effect was shown in the OSS following TSA at 5 years.

Keywords: Shoulder; arthroplasty; patient outcome assessment; patient reported outcome measures; replacement; shoulder scores; total shoulder replacement.

Publication types

Comparative Study

MeSH terms

Aged
Arthroplasty, Replacement, Shoulder* / methods
Female
Hemiarthroplasty* / methods
Humans
Male
Middle Aged
Osteoarthritis* / surgery
Patient Reported Outcome Measures*
Registries*
Shoulder Joint* / surgery
Treatment Outcome
United Kingdom