There has been a shift in US health care to a system that emphasizes value. Patient-reported outcomes have become a critical component of that valuation. A 5-year quality improvement project at the community private practice level was undertaken to assess the authors' delivery of care and practice processes for shoulder surgery as compared with established standards. QuickDASH questionnaires were collected from 1304 consecutive shoulder surgery patients, and data were collected at 4 time points. Mean QuickDASH scores for each procedure and scores assessing biceps tenodesis, distal clavicle excision, workers' compensation status, and sex were analyzed for statistical significance. Rotator cuff repair patients who also underwent biceps tenodesis had statistically significant worse function preoperatively and at 3 and 6 months postoperatively but not at 1 year postoperatively (
P
<.05). Rotator cuff repair patients undergoing concomitant distal clavicle excision had statistically significantly higher pre-operative scores (
P
<.01). Male shoulder arthroplasty patients had statistically significant higher preoperative scores (
P
<.02). Non–workers' compensation patients had statistically significant higher scores at 1 year (
P
<.05), whereas workers' compensation patients were statistically significantly younger (
P
<.01). Maximum changes in scores that met minimal clinically important differences occurred between surgery and 6 months postoperatively in all procedures. Quality outcome studies can be performed in private practice by a single surgeon and yield helpful results that lead to quality improvement through practice and delivery of care processes. [
Orthopedics
. 2020;43(5):e383–e388.]
The patient with a history of shoulder dislocation and subcritical (10%-15%) glenoid bone loss presents a complicated scenario. The "safest" procedure (arthroscopic Bankart repair) may result in a high rate of failure and risk of further surgery. The most successful procedure for avoiding recurrence (Latarjet) comes with potentially high complication rates (of up to 20%), a steep learning curve, risk of permanent nerve injury (up to 15%), and substantial risk of subscapularis deficit. Innovation is most needed in surgery when current treatments lack success or risk significant complications. As surgeons, we are constantly striving to walk the line between using innovative techniques for our patients to better their lives and following the principle "first do no harm." This recent article describes the outcomes of a 2-cm segment of scapular spine harvested through a small incision and stabilized with suture anchors along the anterior glenoid, combined with an arthroscopic labral repair. The technique appears to be safe, and practical, bearing in mind that excellent reported outcomes must be shown to be reproducible. Ideally, we should not have to choose between relatively high failure rates with arthroscopic Bankart repair or the greater reported complication rates with Latarjet. Innovation will pave the way to our greater success.
In an elderly patient with recurrent anterior shoulder dislocation and an irreparable rotator cuff tear, reverse total shoulder arthroplasty (RTSA) is a viable surgical intervention. In the case presented here, RTSA resulted in the patient exhibiting increased range of motion, reporting an improved quality of life, and having no additional dislocation events as of the two-year follow-up.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.