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 Mar 22:S1058-2746(24)00194-0. doi: 10.1016/j.jse.2024.01.053. Online ahead of print.

Authors

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

Affiliations

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

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

Abstract

Introduction: 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.

Method: Records from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man were linked to the PROMs dataset. The study included anatomical 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 2,002 patients were matched on 10 variables using propensity scores. OSSs at 6 months following TSA versus HA were compared in the matched sample.

Results: There was a significant improvement in the OSS in both groups (p<0.001). At 6 months the OSSs were superior following TSA compared to HA (median 42 vs 36, p<0.001). The median score at 5 years was 44 following TSA and 35 following HA. Score distributions were skewed towards the maximum score. The highest possible score (48) was achieved in 28% (134/478) of TSAs and 9% (20/235) 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% (1653/1792) of TSAs and 80% (416/523) of HAs. At 5 years this improvement was maintained in 91% (339/374) of TSAs and 78% (136/174) 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: Arthroplasty; Patient-reported outcome measures; Replacement; Shoulder; Shoulder Scores.