Effect Size in Surgical Intervention Into Shoulder: What Procedures Are Game Changers and What Are Not?

Overview

Journal J Am Acad Orthop Surg Glob Res Rev

Specialty Orthopedics

Date 2020 May 23

PMID 32440636

Citations 1

Authors

Ragu Paraparan

Patrick H Lam

George A C Murrell

Affiliations

Soon will be listed here.

Abstract

Questions: We aimed to determine, from a patient's perspective, which were the most effective commonly performed surgical procedures for disorders of the shoulder and which were not.

Methods: This study was a retrospective analysis of prospectively collected data from patients who underwent shoulder surgery by a single surgeon. To be included, at least 20 patients needed to have undergone that procedure and completed a questionnaire evaluating their shoulders function preoperatively and 6 months postoperatively. The primary outcome was change in response to the question "how is your shoulder overall?" Effect size is reported as Cohen's (standardized mean difference).

Results: Two thousand two hundred six surgical procedures in 13 categories met the inclusion criteria. All procedures were associated with improvements in the patient-ranked overall shoulder status at 6 months ( < 0.01 to < 0.0001). Reverse total shoulder arthroplasty (RTSA) provided the greatest effect size (improvement) in the overall shoulder status (d = 3.14, 95% CI, 2.49 to 3.79), followed by total shoulder arthroplasty (d = 2.60, 95% CI, 2.10 to 3.10) and capsular release (d = 1.41, 95% CI, 1.08 to 1.75). RTSA provided the greatest effect size in patient-reported shoulder pain, whereas capsular release provided the greatest effect size in patient-reported shoulder function. Acromioclavicular joint resection (d = 1.22, 95% CI, 0.56 to 1.88) and acromioplasty (d = 1.29, 95% CI, 0.96 to 1.61) provided the least effect size overall.

Conclusion: All shoulder surgical procedures in this study provided a notable patient-perceived therapeutic benefit in a relatively short period of time (6 months). RTSA, total shoulder arthroplasty, and capsular release are the most effective procedures. Acromioplasty and acromioclavicular resection are the least effective.

Citing Articles

Return to Work Following Shoulder Surgery: An Analysis of 1,773 Cases.

Jayasekara M, Lam P, Murrell G JB JS Open Access. 2020; 5(3).

PMID: 32803105 PMC: 7386555. DOI: 10.2106/JBJS.OA.19.00081.

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