Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain.
JSES Int
; 8(1): 197-203, 2024 Jan.
Article
in En
| MEDLINE
| ID: mdl-38312271
ABSTRACT
Background:
Improvements in pain control after shoulder arthroplasty with a reduction in narcotic use continues to be an important postoperative goal. With the increased utilization of stemless anatomic total shoulder arthroplasty (aTSA), it is relevant to compare between stemmed and stemless arthroplasty to assess if there is any association between this implant design change and early postoperative pain.Methods:
Patients from a multicenter, prospectively-maintained database who had undergone a stemless aTSA with a minimum of two year clinical follow-up were retrospectively identified. Patients who underwent aTSA with a short stem were identified in the same registry, and matched to the stemless aTSA patients by age, sex and preoperative pain score. The primary study outcome was the Visual Analog Scale pain score. Secondary pain outcomes were the American Shoulder and Elbow Surgeons shoulder pain subscore, Western Ontario Osteoarthritis of the Shoulder physical symptoms subscore, and the Single Assessment Numeric Evaluation score. Finally, the percentage of patients who could sleep on the affected shoulder was assessed for each group. These pain-related clinical outcomes were assessed and compared preoperatively, and postoperatively at 9 weeks, 26 weeks, one year and two years. For all statistical comparisons, P > .05 was considered significant.Results:
124 patients were included in the study; 62 in each group. At 9 weeks after surgery, statistically significantly improved pain control was reported by patients undergoing stemless aTSA, as assessed by the Visual Analog Scale (stemless 1.5, stemmed 2.5, P = .001), American Shoulder and Elbow Surgeons pain subscore (stemless 42.4, stemmed 37.3, P < .001), Western Ontario Osteoarthritis of the Shoulder Physical Symptoms (stemless 80.3, stemmed 73.1, P = .006) and Single Assessment Numeric Evaluation (stemless 58.1, stemmed 47.4, P = .011). Patients who underwent a stemless aTSA were significantly more likely to be able to sleep on the affected shoulder at 9 weeks (29% vs. 11%, odds ratio 3.2, 95% confidence interval 1.2-8.4, P = .014). By 26 weeks postoperatively, there were no differences in all pain-specific outcomes. At two years postoperatively, patient-reported outcomes, range of motion, and strength measures were all similar between the two cohorts.Conclusion:
Stemless aTSA provides earlier improvement in postoperative shoulder pain compared to matched patients undergoing short-stem aTSA. Additionally, earlier return to sleeping on the affected shoulder was reported in the stemless aTSA group. The majority of these differences dissipate by 26 weeks postoperatively and there were no differences in pain, patient-reported outcomes, range of motion or strength measures between stemless and short-stem aTSA at 2 years postoperatively.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Language:
En
Journal:
JSES Int
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: