“…Weinberg et al, in a much smaller cohort of 74 patients, similarly demonstrated significant reductions in shoulder-related sleep disturbance following TSA and RSA 8 . Comparisons of TSA and RSA outcomes have been similar across the literature based on improvements in terms of pain and various patient-reported outcome measures (PROMs) 12 , although slight differences in outcome have been observed 13 . Nevertheless, both TSA and RSA provide reliable reduction of pain 14-19 , which has been correlated with improved sleep and ability to sleep on the affected side, as evidenced by the present study and reports in the literature 3,5-8,11 .…”
Background:
Sleep disturbance is commonly reported by patients with arthritis and rotator cuff disease. Small cohort studies have demonstrated sleep improvements following anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). However, to our knowledge, no large cohort study has evaluated sleep improvement after shoulder arthroplasty. The purpose of the present study was to determine the effects of shoulder arthroplasty on sleep improvement, including the speed of sleep recovery, improvement plateaus, and any differences observed between TSA and RSA.
Methods:
A retrospective analysis of our institution’s shoulder and elbow repository evaluated patients who had been managed with TSA and RSA between 2012 and 2021. Our analysis focused on visual analog scale (VAS) pain scores as well as specific sleep-related questions included in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Preoperative characteristics were compared, and comparisons at the 3-month, 6-month, 1-year, and most recent follow-ups were performed to evaluate the efficacy of improvement, speed of recovery, improvement plateaus, and differences among implant types.
Results:
Our search identified 1,405 patients who were treated with shoulder arthroplasty, including 698 who underwent TSA and 707 who underwent RSA. Six hundred and seventy-six (97%) of those who underwent TSA and 670 (95%) of those who underwent RSA reported sleep disturbance prior to surgery and were eligible for inclusion. With the exclusion of 357 patients without complete follow-up, 989 patients (517 who underwent TSA and 472 who underwent RSA) met the inclusion criteria, with a median follow-up of 36 months for the TSA group and 25 months for the RSA group. Postoperatively, significant improvements in the ability to sleep comfortably and sleep on the affected side were observed in both the TSA group and the RSA group (p < 0.001). The ability to sleep comfortably returned faster than the ability to sleep on the affected side, with the ability to sleep comfortably reaching a plateau at 3 months and the ability to sleep on the affected side reaching a plateau at 6 months. Despite improvements in terms of sleep disturbance, at the time of most recent follow-up, 13.2% of patients in the TSA group and 16.0% of those in the RSA group could not sleep comfortably and 31.4% of those in the TSA group and 36.8% of those in the RSA group could not sleep on the operative side.
Conclusions:
The results of the study demonstrated that both TSA and RSA provide significant and rapid improvement in patients’ ability to sleep comfortably and, to a lesser extent, improves their ability to sleep on their affected side.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
“…Weinberg et al, in a much smaller cohort of 74 patients, similarly demonstrated significant reductions in shoulder-related sleep disturbance following TSA and RSA 8 . Comparisons of TSA and RSA outcomes have been similar across the literature based on improvements in terms of pain and various patient-reported outcome measures (PROMs) 12 , although slight differences in outcome have been observed 13 . Nevertheless, both TSA and RSA provide reliable reduction of pain 14-19 , which has been correlated with improved sleep and ability to sleep on the affected side, as evidenced by the present study and reports in the literature 3,5-8,11 .…”
Background:
Sleep disturbance is commonly reported by patients with arthritis and rotator cuff disease. Small cohort studies have demonstrated sleep improvements following anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). However, to our knowledge, no large cohort study has evaluated sleep improvement after shoulder arthroplasty. The purpose of the present study was to determine the effects of shoulder arthroplasty on sleep improvement, including the speed of sleep recovery, improvement plateaus, and any differences observed between TSA and RSA.
Methods:
A retrospective analysis of our institution’s shoulder and elbow repository evaluated patients who had been managed with TSA and RSA between 2012 and 2021. Our analysis focused on visual analog scale (VAS) pain scores as well as specific sleep-related questions included in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Preoperative characteristics were compared, and comparisons at the 3-month, 6-month, 1-year, and most recent follow-ups were performed to evaluate the efficacy of improvement, speed of recovery, improvement plateaus, and differences among implant types.
Results:
Our search identified 1,405 patients who were treated with shoulder arthroplasty, including 698 who underwent TSA and 707 who underwent RSA. Six hundred and seventy-six (97%) of those who underwent TSA and 670 (95%) of those who underwent RSA reported sleep disturbance prior to surgery and were eligible for inclusion. With the exclusion of 357 patients without complete follow-up, 989 patients (517 who underwent TSA and 472 who underwent RSA) met the inclusion criteria, with a median follow-up of 36 months for the TSA group and 25 months for the RSA group. Postoperatively, significant improvements in the ability to sleep comfortably and sleep on the affected side were observed in both the TSA group and the RSA group (p < 0.001). The ability to sleep comfortably returned faster than the ability to sleep on the affected side, with the ability to sleep comfortably reaching a plateau at 3 months and the ability to sleep on the affected side reaching a plateau at 6 months. Despite improvements in terms of sleep disturbance, at the time of most recent follow-up, 13.2% of patients in the TSA group and 16.0% of those in the RSA group could not sleep comfortably and 31.4% of those in the TSA group and 36.8% of those in the RSA group could not sleep on the operative side.
Conclusions:
The results of the study demonstrated that both TSA and RSA provide significant and rapid improvement in patients’ ability to sleep comfortably and, to a lesser extent, improves their ability to sleep on their affected side.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
“…Thomas Jefferson University HS, Rothman Institute of Orthopaedics, Philadelphia [ 35 , 44 , 66 , 325 , 581 , 627 ] Texas 1. FORI (Shoulder) [ 153 , 182 , 183 , 424 , 526 , 566 , 567 , 604 ] 2. Texas Southwestern University [ 211 , 459 ] Virginia OrthoVirginia [ 287 , 547 ] ABJHI Alberta Bone and Joint Health Institute, CHKR Center for Hip and Knee Replacement Joint Registry, CJRI Connecticut Joint Replacement Institute, CJRR California Joint Replacement Registry, FOI Florida Orthopaedic Institute, Shoulder, FORI Fondren Orthopedic Research Institute, H&K Hip and Knee, HS Hospital, JAR Joint Arthroplasty Registry, JRR Joint Replacement Registry, MARCQI Michigan Collaborative Quality Initiative, NY New York, RG Registry, OJRR Ontario Joint Replacement Registry, PAR Partners Massachusetts Registry, S&E Shoulder and Elbow, TJA Total Joint Arthroplasty, TKA Total Knee Arthroplasty [] Numbers in parentheses are the relevant references Fig.…”
Purpose
Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II–IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II–IV JARs must be created to effectively assess and categorize these data.
Methods
Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II–IV JARs worldwide. The secondary aim was to record their lifetime, publications’ number and frequency and recognise differences with national JARs.
Results
One hundred five Level II–IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case–control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.
Conclusions
This is the first study mapping all Level II–IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
“…3,5,6 During the past few decades however, concerns in regard to rotator cuff failure following aTSA in older patients with primary glenohumeral osteoarthritis, have become more prevalent. 7 The reported rate of cuff failure following aTSA in patients aged over 70 has been reported around 1% according to certain studies, 8 while other studies note a higher rate of rotator cuff failure around 11% in patients aged over 80, which necessitates conversion to rTSA. 9 These concerns have led to an increased incidence of rTSA, with shoulder surgeons increasingly likely to council their elderly patients aged over 70 in favor of rTSA, irrespective of the state of their rotator cuff, due to the high rates of postoperative satisfaction achieved.…”
This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.
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