Establishing maximal medical improvement after anatomic total shoulder arthroplasty

Background: As a heightened emphasis continues to be placed on value-based health care, quality outcomes following orthopedic procedures must be properly defined. With knowledge of the time to maximal medical improvement following total shoulder arthroplasty (TSA), physician resources can be justly allocated to optimize value in ambulatory orthopedic care.

Materials and methods: A systematic review was conducted to identify studies reporting sequential follow-up at several time points, up to a minimum of 2 years after TSA. Assessment for clinically significant improvements between time intervals was made by using the minimal clinically important difference specific to each patient-reported outcome measure.

Results: We identified 13 studies that fit the criteria to be included in this review, amounting to 984 patients who underwent TSA. Clinically significant improvements in patient-reported outcome scores were appreciated up to 1 year following TSA, but no further clinical significance was seen from 1 year to 2 years. Objective physical examination measurements followed a similar trend, with clinically significant improvements in abduction occurring up to 1 year postoperatively. For both the subjective and objective outcomes, the majority of improvements occurred in the first 3 months after the procedure.

Conclusions: Following TSA, clinically significant improvements in patient-reported outcomes and objective clinical measurements are seen up to 1 year postoperatively but not beyond this time. This result is important for counseling patients and modifying their expectations prior to surgery as well as for establishing a time frame for maximized outcome evaluation to define the value received from TSA.