The Journal of Bone and Joint Surgery 82:970 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
The Effect of Surgery for Rotator Cuff Disease on General Health Status
Results of a Prospective Trial*
Michael D. McKee , M.D., F.R.C.S.(C) and
Daniel J. Yoo, B.Sc.
Investigation performed at the Division of Orthopaedics,
Department of Surgery, Upper Extremity Reconstructive Service, St.
Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Division of Orthopaedics, Department of Surgery, Upper Extremity
Reconstructive Service, St. Michael's Hospital and the University
of Toronto, 55 Queen Street East, Suite 800, Toronto, Ontario M5C
1R6, Canada. E-mail address for M. D. McKee: mckee{at}the-wire.com
Background: Previous studies of the effect
of rotator cuff surgery have concentrated on limb-specific or surgeon-based
outcome criteria. We conducted a prospective trial to determine
the effect of surgery for rotator cuff disease on general health
status.
Methods: Seventy-one patients (fifty of whom
were men and twenty-one of whom were women) with a mean age of 56.1
years were enrolled in the study. In addition to routine clinical
and radiographic evaluation, all patients completed the Short Form-36
(SF-36) health-status questionnaire and five limb-specific questionnaires
preoperatively and at six, twelve, eighteen, and twenty-four months postoperatively.
All patients had a standard open acromioplasty and resection of
the subacromial bursa. Thirty-one patients had repair of an associated
rotator cuff tear. Sixty-seven patients (94 percent) completed the
study; the remaining four patients were lost to follow-up.
Results: The preoperative SF-36 scores for physical
function (60.6, p = 0.02), role function-physical (20.8, p = 0.001),
pain (38.6, p = 0.003), physical component summary (37.0, p = 0.001),
and mental component summary (45.6, p = 0.02) were significantly
decreased compared with normative data. The preoperative limb-specific
scores also were low. At the time of the most recent follow-up evaluation,
there was improvement that approached or reached significance both
in the limb-specific scores (p £ 0.0026) and in the general-health-status
scores for pain (p = 0.0001), role function-physical (p = 0.06),
vitality (p = 0.01), and physical component summary (p = 0.01).
The presence of a rotator cuff tear had a significant negative effect
on limb-specific scores both preoperatively (p = 0.04) and postoperatively
(p = 0.05). Although operative treatment of rotator cuff disease
led to improved scores, patients who had filed a Workers' Compensation
claim had lower limb-specific and SF-36 scores both preoperatively
(p = 0.02 and p = 0.01, respectively) and postoperatively (p = 0.01
and p = 0.005, respectively).
Conclusions: Surgery for chronic rotator cuff
disease reliably and significantly improves general health status.
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