Judging success...PO Day 121

In an article reprinted by the NIH from the Open Orthopedic Journal in 2010, Canadian authors : Roy, MacDermid, Goel, Faber, Athwal and Drosdowech addressed the subject of what makes for a successful outcome with reverse Total Shoulder Arthroplasty. It seems that there are subjective ways to judge the result and objective ways to look at it and in the end they do not necessarily agree.

Objectively, 51 patients were screened using various exams including the SST (Simple Shoulder Test), ROM, and strength testing. Subjectively, they were individually interviewed as to their overall satisfaction with their shoulder care.  Follow up was in the range of two years post surgery.

At the two year interview 93% of the patients were satisfied with their care. Only 7% were unsatisfied. The 7% consisted of only three patients; one had experienced a dislocation, one had a very low SST score (able to perform only2 of 12 standard actions) and the third had no apparent reason for dissatisfaction as he had no complications and scored 100% on the SST exam. Of the 93% (48 individuals) who expressed satisfaction with the surgical results, 32% (14 patients) were objectively characterized as having a poor outcome with substantial complications.

Patient satisfaction exceeded 90% in spite of residual pain, limited range of motion, strength deficit and functional limitations. The data suggested "that patients' satisfaction with their care rating is a poor indicator of shoulder  function."  Complications appeared to affect the doctor's perspective on surgical success more than they did the patients' opinion.

My conclusion, not necessarily the authors', is that the typical rTSA patient is older and has had a good bit of pain prior to surgery. While the surgeon's expectations might be high, the patient may find even modest functional improvement and modest relief of pain quite satisfactory and tolerates complications better than the surgeon who finds them distressing. Furthermore, the study did suggest that the overall satisfaction of the patient might be influenced by the care and attention received more than by statistical results.

I hope I have presented a reasonably accurate summary of their excellent report. I think it speaks well for the spirit and resilience of the rTSA demographic.

http://youtu.be/b2ff8qXa248

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--