2002 - University of Washington Bone and Joint Sources

90
80
70
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0
90
80
70
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Figure 2: Preoperative and postoperative SF-36 scores for total shoulder arthroplasty compared to
weighted means for total hip arthroplasty reported in the literature.
general health perception). These
differences were statistically significant.
After the surgery, although the amount
of difference was much smaller, the
scores for patients were still lower than
population controls for most SF-36
dimensions (Figure 1). Preoperatively,
TSA patients scored higher than THA
patients on all SF-36 dimensions.
Postoperatively, there was little
difference between the TSA and the
THA patients (Figure 2). Similarly, the
TSA patients scored higher than the
CABG patients in all SF-36 dimensions
TSA pre-op
TSA post-op
THA pre-op
THA post-op
TSA pre-op
TSA post-op
CABG pre-op
CABG post-op
Figure 3: Preoperative and postoperative SF-36 scores for total shoulder arthroplasty compared to
weighted means for coronary bypass graft procedures reported in the literature.
preoperatively. After surgery, the TSA
patients scored better or equal to the
CABG patients (Figure 3).
DISCUSSION
The patients in this study
experienced significant improvements
in their health- related quality of life
following TSA for glenohumeral
osteoarthritis. These improvements in
multiple dimensions of the SF-36 were
durable, since these gains were
documented between 30 and 60
months postoperatively. This study also
documents the diminished quality of
life of individuals coming to surgery for
glenohumeral osteoarthritis. In six out
of eight SF-36 dimensions, the
preoperative SF-36 scores for these
patients was significantly lower than
that of age- and gender-matched
population controls. These scores
improved after surgery, but did not
reach the levels found in the control
population (Radosevich et al, 1994).
As increasing attention is focused
on health care costs, the value of
surgical interventions to the patient and
the relative value of these procedures
need to be well documented. In this
spirit, we compared the changes in
patient health status following TSA to
the previously reported changes in
quality of life following total hip
arthroplasty, which is considered to be
a very effective procedure. We observed
that the SF-36 scores for patients with
arthritis of the hip were lower than
those of patients with shoulder
arthritis. Postoperatively, both
reconstructive procedures (total
shoulder and total hip) demonstrated
a similar effectiveness in improving
quality of life.
We also compared our results to
another chronic medical condition
which affects patients of a similar age,
and for which the surgical solution is
generally believed to be very effective:
coronary artery bypass graft surgery.
Patients with shoulder osteoarthritis
appeared to score generally lower on the
comfort score than those patients with
chronic angina. In the other six healthrelated
quality of life dimensions
however, the patients with
glenohumeral osteoarthritis tended not
to score as low as the chronic angina
patients did preoperatively.
Postoperatively however, the total
shoulder patients, and the CABG
patients were brought up to similar
levels for all eight SF-36 dimensions.
In conclusion, this study has shown
that total shoulder arthroplasty can
improve the quality of life in patients
with glenohumeral osteoarthritis
several years after surgery.
Postoperative SF-36 scores were lower
than the control population, but they
were similar to those previously
reported for other effective orthopaedic
and cardiac procedures.
36 2002 ORTHOPAEDIC RESEARCH REPORT