Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
A Systematic Review and Meta-Analysis of the Impact of Total Shoulder Arthroplasty on Health-Related Quality of Life.
Carter1, Michael J., Mikuls1, Ted R., Nayak2, Smita, Fehringer1, Edward V., Michaud1, Kaleb D.
Total shoulder arthroplasty (TSA) is becoming more common as an arthritis treatment. However, the effect of TSA on health related quality of life (HRQoL) has not been established. The goal of this systematic review and meta-analysis was to characterize the change in HRQoL as a result of TSA. A quantitative value would establish the potential benefit from the procedure, and also help to evaluate future modifications to the TSA procedure.
We identified published studies that showed preoperative and postoperative HRQoL outcomes for patients receiving TSA. Articles were included if: 1) patients received primary TSA with an unconstrained prosthesis, with synthetic humeral and glenoid components, and 2) preoperative and postoperative HRQoL measures with at least 6 months of follow-up were reported. Reports were examined to identify all HRQoL measures reported, and meta-analysis was used to calculate standardized mean differences (SMD, reflective of the effect size) and 95% confidence intervals (CI) for each scale.
There were 20 studies (1576 total shoulders) examining TSA outcomes meeting criteria for inclusion in the meta-analysis. Nearly all shoulders had treatment indications of primary osteoarthritis (n=1499) and rheumatoid arthritis (n=60). The most commonly examined HRQoL outcome measures included the Short Form-36 (SF-36), the visual analog scale for pain (VAS), and three shoulder specific measures: Constant score, American Shoulder and Elbow Surgeons score (ASES), and Simple Shoulder Test (SST). Effects of TSA on study outcomes are summarized in the Table, with the average follow-up at 45.2 months:
|HRQoL Outcome (number of studies reporting)||Standardized Mean Difference (95% CI)||Mean Difference in Outcome Measure (SD)|
|SF-36 physical component score (n = 4)||0.69 (0.52 to 0.86)||7.02 (1.78)|
|SF-36 mental component score (n = 4)||-0.04 (-0.20 to 0.13)||-0.10 (3.56)|
|Constant score (n = 11)||2.67 (2.55 to 2.79)||38.1 (19.9)|
|ASES (n = 5)||2.61 (2.43 to 2.80)||53.6 (25.3)|
|SST (n = 3)||2.20 (1.96 to 2.44)||6.51 (2.60)|
|Pain VAS (n = 5)||-2.63 (-2.86 to -2.40)||-5.79 (2.58)|
Total shoulder arthroplasty is efficacious, offering significant improvement in both function and pain. Shoulder-specific measures demonstrate far greater changes postoperatively than does the global SF-36 instrument. However, the change in SF-36 physical component score is statistically significant, and an SMD of 0.69 is a moderate to large effect size. Because most patients receive TSA on an elective basis, establishing the effect of TSA on HRQoL measures via systematic review and meta-analysis has important implications for both patients and payers.
To cite this abstract, please use the following information:
Carter, Michael J., Mikuls, Ted R., Nayak, Smita, Fehringer, Edward V., Michaud, Kaleb D.; A Systematic Review and Meta-Analysis of the Impact of Total Shoulder Arthroplasty on Health-Related Quality of Life. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :168