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The Journal of Bone and Joint Surgery (American) 84:1349-1353 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Characterizing the Functional Improvement After Total Shoulder Arthroplasty for Osteoarthritis

Edward V. Fehringer, MD, Branko Kopjar, MD, PhD, Richard S. Boorman, MD, R. Sean Churchill, MD, Kevin L. Smith, MD and Frederick A. Matsen, III, MD

Investigation performed at the Department of Orthopaedics and Sports Medicine and the Department of Health Services, University of Washington, Seattle, Washington

Edward V. Fehringer, MD
Branko Kopjar, MD, PhD
Richard S. Boorman, MD
R. Sean Churchill, MD
Kevin L. Smith, MD
Frederick A. Matsen III, MD
Department of Orthopaedics and Sports Medicine (E.V.F., R.S.B., R.S.C., K.L.S., and F.A.M. III) and Department of Health Services (B.K.), University of Washington, 1959 N.E. Pacific Street, Seattle, WA 98195.
E-mail address for F.A. Matsen III: matsen{at}u.washington.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Both shoulder surgeons and patients who are considering total shoulder arthroplasty are interested in the anticipated improvement in shoulder comfort and function after the procedure. The purpose of the present study was to characterize shoulder-specific functional gains in relation to preoperative shoulder function and to present this information in a way that can be easily communicated to patients who are considering this surgery.

Methods: We analyzed the preoperative and follow-up shoulder function in patients managed with total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis. Functional self-assessments were available for 102 (80%) of 128 shoulders after thirty to sixty months of follow-up. Outcome was assessed with respect to the change in the number of shoulder functions that were performable, the change in shoulder function as a percentage of the preoperative functional deficit, and the change in the ability to perform specific shoulder functions.

Results: The average number of shoulder functions that were performable improved from four of twelve preoperatively to nine of twelve postoperatively (p < 0.01). Function improved in ninety-six shoulders (94%). The number of functions that were performable at the time of follow-up was positively associated with preoperative shoulder function (p < 0.05): the better the preoperative function, the better the follow-up function. The improvement in function was greatest for shoulders with less preoperative function (p < 0.01). On the average, patients regained approximately two-thirds of the functions that had been absent preoperatively. Significant improvement was noted in eleven of the twelve shoulder functions that were examined (p < 0.01). The chance of regaining a function that had been absent before surgery was 73%, whereas the chance of losing a function that had been present before surgery was 6%. Older men tended to have greater functional improvement than younger men.

Conclusion: Total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis significantly improves shoulder function. Postoperative function is related to preoperative function. The improvement that was observed in this clinical series can be conveyed to patients most simply by stating that, after surgery, shoulders typically regained approximately two-thirds of the functions that had been absent preoperatively.


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