Abstract：
BACKGROUND: Recovery after anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) has many similarities; however, recently surgeons have suggested patients undergoing rTSA have a less difficult postoperative course with less pain compared with aTSA patients. Given the heightened awareness to postoperative pain control and opioid consumption, as well as the expanding indications for rTSA, we sought to determine the differences in pain and opioid consumption between aTSA and rTSA patients in a 12-week postoperative period.
METHODS: A retrospective chart review was performed to identify all patients who underwent a primary aTSA or rTSA from January 2013 to April 2018 at a single institution. Patients with recorded visual analog scale (VAS) and American Shoulder and Elbow Surgeons scores were included for analysis. Revision arthroplasties were excluded. VAS scores were recorded preoperatively and at standard 2-week, 6-week, and 12-week postoperative time points. P values < .05 were considered statistically significant, except where Bonferroni corrections were applied.
RESULTS: A total of 690 patients underwent TSA (278 aTSA, 412 rTSA). Preoperatively, aTSA and rTSA patient groups had similar VAS scores (6 vs. 6, P = .38). Postoperatively, the aTSA group had a higher VAS at the 6-week visit, compared with rTSA patients (2.8 vs. 2.2, P = .003). aTSA patients remained on opioids at a higher rate at the 2-week (62.4% vs. 45.6%, P ≤ .001) time period. aTSA patients needed more opioid prescription refills before the 2-week (61.7% vs. 45.5%, P ≤ .001) and 6-week (40.4% vs. 30.7%, P = .01) follow-up visits.
CONCLUSIONS: Despite similar preoperative VAS and rates of preoperative opioid use, aTSA patients required more opioid medication refills and remained on opioids for a longer duration in the early postoperative period to achieve similar postoperative pain control as indicated by similar VAS. This study suggests that the recovery from rTSA is less difficult compared with aTSA as indicated by VAS and opioid consumption.
METHODS: A retrospective chart review was performed to identify all patients who underwent a primary aTSA or rTSA from January 2013 to April 2018 at a single institution. Patients with recorded visual analog scale (VAS) and American Shoulder and Elbow Surgeons scores were included for analysis. Revision arthroplasties were excluded. VAS scores were recorded preoperatively and at standard 2-week, 6-week, and 12-week postoperative time points. P values < .05 were considered statistically significant, except where Bonferroni corrections were applied.
RESULTS: A total of 690 patients underwent TSA (278 aTSA, 412 rTSA). Preoperatively, aTSA and rTSA patient groups had similar VAS scores (6 vs. 6, P = .38). Postoperatively, the aTSA group had a higher VAS at the 6-week visit, compared with rTSA patients (2.8 vs. 2.2, P = .003). aTSA patients remained on opioids at a higher rate at the 2-week (62.4% vs. 45.6%, P ≤ .001) time period. aTSA patients needed more opioid prescription refills before the 2-week (61.7% vs. 45.5%, P ≤ .001) and 6-week (40.4% vs. 30.7%, P = .01) follow-up visits.
CONCLUSIONS: Despite similar preoperative VAS and rates of preoperative opioid use, aTSA patients required more opioid medication refills and remained on opioids for a longer duration in the early postoperative period to achieve similar postoperative pain control as indicated by similar VAS. This study suggests that the recovery from rTSA is less difficult compared with aTSA as indicated by VAS and opioid consumption.
摘要：
背景：解剖全肩关节置换术（aTSA）和反向全肩关节置换术（rTSA）后的恢复有许多相似之处；但是，最近，外科医生认为，与aTSA患者相比，接受rTSA的患者术后过程难度较小，疼痛较少。鉴于人们对术后疼痛控制和阿片类药物消耗的认识提高，以及rTSA的适应症不断扩大，我们试图确定aTSA和rTSA患者术后12周疼痛和阿片类药物用量的差异.
方法：进行回顾性分析，以确定2013年1月至2018年4月在单一机构接受原发性aTSA或rTSA的所有患者。纳入记录了视觉模拟量表（VAS）和美国肩肘外科医生（ASES）评分的患者进行分析。排除了翻修性关节置换术。术前和标准2周记录VAS评分，6周,术后12周时间点。P值<0.05被认为具有统计学意义，除了应用Bonferroni校正的地方。
结果：共有690例患者接受了TSA（278aTSA，412rTSA）。术前,aTSA和rTSA患者组的VAS评分相似（6vs6，P=0.38）。术后,在为期6周的访问中，aTSA组的VAS较高，与rTSA患者相比（2.8vs2.2，P=0.003）。ATSA患者仍在阿片类药物在2周(62.4%vs45.6%,P=<0.001）时间段。ATSA患者需要更多的阿片类药物处方补充前2周(61.7%vs45.5%,P=<0.001）和6周（40.4%vs30.7%，P=0.01)随访。
结论：尽管术前VAS和阿片类药物使用率相似，aTSA患者需要更多的阿片类药物再填充，并在术后早期保持阿片类药物更长的时间，以实现类似的术后疼痛控制，如类似的VAS所示。这项研究表明，与VAS和阿片类药物消耗所表明的aTSA相比，从rTSA中的回收难度较小。
方法：进行回顾性分析，以确定2013年1月至2018年4月在单一机构接受原发性aTSA或rTSA的所有患者。纳入记录了视觉模拟量表（VAS）和美国肩肘外科医生（ASES）评分的患者进行分析。排除了翻修性关节置换术。术前和标准2周记录VAS评分，6周,术后12周时间点。P值<0.05被认为具有统计学意义，除了应用Bonferroni校正的地方。
结果：共有690例患者接受了TSA（278aTSA，412rTSA）。术前,aTSA和rTSA患者组的VAS评分相似（6vs6，P=0.38）。术后,在为期6周的访问中，aTSA组的VAS较高，与rTSA患者相比（2.8vs2.2，P=0.003）。ATSA患者仍在阿片类药物在2周(62.4%vs45.6%,P=<0.001）时间段。ATSA患者需要更多的阿片类药物处方补充前2周(61.7%vs45.5%,P=<0.001）和6周（40.4%vs30.7%，P=0.01)随访。
结论：尽管术前VAS和阿片类药物使用率相似，aTSA患者需要更多的阿片类药物再填充，并在术后早期保持阿片类药物更长的时间，以实现类似的术后疼痛控制，如类似的VAS所示。这项研究表明，与VAS和阿片类药物消耗所表明的aTSA相比，从rTSA中的回收难度较小。
