Abstract：
BACKGROUND: Satisfaction following shoulder arthroplasty (TSA), which is commonly reported using patient-reported outcome measures (PROMs), is partially dependent upon restoring shoulder range of motion (ROM). We hypothesized there exists a minimum amount of ROM necessary to perform functional tasks queried in PROM questionnaires, beyond which further ROM may provide no further improvement in PROMs.
METHODS: A retrospective review of a multicenter international shoulder arthroplasty database was performed between 2004-2020 for patients undergoing anatomic or reverse TSA (aTSA, rTSA) with minimum 2-year follow-up. Our primary outcome was to determine the threshold in postoperative active ROM (abduction, forward elevation [FE], external rotation [ER], and internal rotation [IR] score) whereby additional improvement was not associated with additional improvement in PROMs (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons [ASES] score, and the Shoulder Pain and Disability Index [SPADI]). For comparison, we also evaluated the Shoulder Arthroplasty Smart (SAS) score, which is not subject to the ceiling effect.
RESULTS: We included 4,459 TSAs (1,802 aTSAs, 2,657 rTSAs) with minimum 2-year follow-up (mean, 56±32 months). The threshold in postoperative ROM that were associated with no further improvement were: active abduction, 107-113° for PROMs versus 163° for the SAS score; active FE, 149-162° for PROMs versus 176° for the SAS score; active ER, 50-52° for PROMs versus 72° for the SAS score; IR score, 4-5 points for all PROMs versus 6 points for the SAS score. Out of 3,508 TSAs with complete postoperative ROM data, 8.5% achieved or exceeded all ROM thresholds (14.5% aTSAs, 4.8% rTSAs).
CONCLUSIONS: Our findings demonstrate that postoperative ROM exceeding 113° of abduction, 162° of FE, 52° of ER, and IR to L1 is associated with minimal additional improvement in PROMs. While individual patient needs vary, the thresholds may provide helpful targets for patients undergoing postoperative rehabilitation.
METHODS: A retrospective review of a multicenter international shoulder arthroplasty database was performed between 2004-2020 for patients undergoing anatomic or reverse TSA (aTSA, rTSA) with minimum 2-year follow-up. Our primary outcome was to determine the threshold in postoperative active ROM (abduction, forward elevation [FE], external rotation [ER], and internal rotation [IR] score) whereby additional improvement was not associated with additional improvement in PROMs (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons [ASES] score, and the Shoulder Pain and Disability Index [SPADI]). For comparison, we also evaluated the Shoulder Arthroplasty Smart (SAS) score, which is not subject to the ceiling effect.
RESULTS: We included 4,459 TSAs (1,802 aTSAs, 2,657 rTSAs) with minimum 2-year follow-up (mean, 56±32 months). The threshold in postoperative ROM that were associated with no further improvement were: active abduction, 107-113° for PROMs versus 163° for the SAS score; active FE, 149-162° for PROMs versus 176° for the SAS score; active ER, 50-52° for PROMs versus 72° for the SAS score; IR score, 4-5 points for all PROMs versus 6 points for the SAS score. Out of 3,508 TSAs with complete postoperative ROM data, 8.5% achieved or exceeded all ROM thresholds (14.5% aTSAs, 4.8% rTSAs).
CONCLUSIONS: Our findings demonstrate that postoperative ROM exceeding 113° of abduction, 162° of FE, 52° of ER, and IR to L1 is associated with minimal additional improvement in PROMs. While individual patient needs vary, the thresholds may provide helpful targets for patients undergoing postoperative rehabilitation.
摘要：
背景：肩关节置换术（TSA）后的满意度，通常使用患者报告的结果测量(PROM)报告，部分取决于恢复肩部运动范围(ROM)。我们假设存在执行PROM问卷中查询的功能任务所需的最小ROM量，
方法：在2004-2020年期间，对接受解剖或反向TSA的患者进行了多中心国际肩关节成形术数据库的回顾性审查（aTSA，rTSA）至少随访2年。我们的主要结果是确定术后活动性ROM的阈值（外展，向前高程[FE]，外旋转[ER]，和内部旋转[IR]评分），其中额外的改善与PROM的额外改善无关（简单肩部测试[SST]，美国肩肘外科[ASES]评分，和肩痛和残疾指数[SPADI])。为了比较，我们还评估了肩关节成形术智能（SAS）评分，不受天花板效应的影响。
结果：我们包括4,459个TSA（1,802个TSA，2657rTSA），至少2年随访（平均，56±32个月）。与无进一步改善相关的术后ROM阈值为：主动外展，PROM为107-113°，SAS评分为163°；活动FE，PROM为149-162°，SAS评分为176°；活动ER，PROM为50-52°，SAS评分为72°；IR评分，所有PROM得4-5分，SAS得6分。在具有完整术后ROM数据的3,508个TSA中，8.5%达到或超过所有ROM阈值(14.5%aTSAs，4.8%rTSA）。
结论：我们的研究结果表明，术后ROM超过113°外展，162°的FE，52°ER,andIRtoL1isassociatedwithminimumadditionalimprovementinPROM.Whileindividualpatientneedsvary,这些阈值可能为接受术后康复的患者提供有用的目标。
方法：在2004-2020年期间，对接受解剖或反向TSA的患者进行了多中心国际肩关节成形术数据库的回顾性审查（aTSA，rTSA）至少随访2年。我们的主要结果是确定术后活动性ROM的阈值（外展，向前高程[FE]，外旋转[ER]，和内部旋转[IR]评分），其中额外的改善与PROM的额外改善无关（简单肩部测试[SST]，美国肩肘外科[ASES]评分，和肩痛和残疾指数[SPADI])。为了比较，我们还评估了肩关节成形术智能（SAS）评分，不受天花板效应的影响。
结果：我们包括4,459个TSA（1,802个TSA，2657rTSA），至少2年随访（平均，56±32个月）。与无进一步改善相关的术后ROM阈值为：主动外展，PROM为107-113°，SAS评分为163°；活动FE，PROM为149-162°，SAS评分为176°；活动ER，PROM为50-52°，SAS评分为72°；IR评分，所有PROM得4-5分，SAS得6分。在具有完整术后ROM数据的3,508个TSA中，8.5%达到或超过所有ROM阈值(14.5%aTSAs，4.8%rTSA）。
结论：我们的研究结果表明，术后ROM超过113°外展，162°的FE，52°ER,andIRtoL1isassociatedwithminimumadditionalimprovementinPROM.Whileindividualpatientneedsvary,这些阈值可能为接受术后康复的患者提供有用的目标。
