When it comes to reverse total shoulder arthroplasty, is gender associated with differences in measures like the Simple Shoulder Test (SST) and the American Shoulder and Elbow Surgeons (ASES) Shoulder score?
How Do Age or Gender Affect Shoulder Surgery?
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How about age?
A new multicenter study set out to answer these questions and more. The paper, “Are Age and Patient Gender Associated with Different Rates and Magnitudes of Clinical Improvement After Reverse Shoulder Arthroplasty?” appears in the June 2018 edition of The Clinical Orthopedics and Related Research Journal.
According to the authors, “An improved understanding of how gender differences and the natural aging process are associated with differences in clinical improvement in outcome metric scores and ROM measurements after reverse total shoulder arthroplasty (rTSA) may help physicians establish more accurate patient expectations for reducing postoperative pain and improving function.”
“We quantified and analyzed the outcomes of 660 patients (424 women and 236 men; average age, 72 ± 8 years; rang, 43-95 years) with cuff tear arthropathy or osteoarthritis and rotator cuff tear who were treated with rTSA by 13 shoulder surgeons from a longitudinally maintained international database using a linear mixed effects statistical model to evaluate the relationship between clinical improvements and gender and patient age.”
Co-author, Richard Friedman, M.D., FRCSC, chief, shoulder and elbow surgery, professor of orthopedics, Medical University of South Carolina told OTW, “There was little literature about how outcomes in reverse TSA differ based on age or sex. There was a lack of knowledge to issues that we should have had answers for, and we felt we could answer these questions.”
“The most important findings were that both age and sex affect the outcomes of reverse TSA. This information can help surgeons align patient expectations with expected outcomes based on their age and sex, and with appropriate patient expectations, outcome and patient satisfaction are improved.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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