Key result
Females undergoing reverse total shoulder arthroplasty present with clinically lower preoperative PROMIS physical function than males.
Why the study?
Studies have reported lower postoperative PROMIS scores in females after shoulder surgery, but had not focused on a dedicated cohort of shoulder arthroplasty patients or examined upstream preoperative differences.
Are there sex-based differences in baseline PROMIS scores among patients undergoing anatomic or reverse total shoulder arthroplasty?
Observational (n=187)
Are there sex-based differences in baseline PROMIS scores among patients undergoing anatomic or reverse total shoulder arthroplasty?
p-value: p=<.05
Female patients undergoing reverse total shoulder arthroplasty have significantly lower baseline physical function scores than males, which may confound postoperative outcome comparisons.
May confound sex-based outcome comparisons after reverse TSA; supports sex adjustment in future PROMIS analyses.
Background Patient-reported outcome measures (PROMs) are increasingly used to evaluate outcomes in patients undergoing shoulder arthroplasty. The Patient-Reported Outcome Measures Information System (PROMIS) is popular due to low cost and question burden. Females have been reported to have lower postoperative PROMIS scores after shoulder surgery, but studies have not focused on a dedicated cohort of shoulder arthroplasty patients or examined upstream differences in preoperative scores. This study aimed to characterize sex differences in baseline PROMIS scores among anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) patients. Methods Data were collected over a 9-month period. Demographics, Charlson Comorbidity Index (CCI), smoking status, BMI, American Shoulder and Elbow Surgeons (ASES) scores, PROMIS Pain, Physical Function (PF), Upper Extremity, Depression, and Anxiety scores, as well as Single Assessment Numeric Evaluation (SANE) scores were collected. Student t-tests were performed to determine correlation with baseline PROMs. A minimal clinically important difference (MCID) of 4 was used to determine if a PROMIS score difference between groups was clinically important. Significance was set as P < .05. Results A total of 88 females (34 TSAs 54 rTSA) and 99 males (35 TSA, 64 rTSA) were enrolled. Only sex showed a correlation with preoperative PROMIS score. In rTSA patients, females had significantly lower preoperative PROMIS PF scores ( P < .05). Among females undergoing TSA vs. rTSA, lower preoperative PROMIS PF scores were found in rTSA ( P < .05). These differences exceeded the MCID of 4. The same difference was not found in men undergoing TSA vs. rTSA. Conclusion Preoperative sex-based differences in PROMIS scores are underappreciated in the shoulder arthroplasty literature. This is the largest study to date focusing on sex-based differences among a dedicated cohort of TSA and rTSA patients, showing a difference in baseline PROMIS scores between males and females above the MCID. These findings suggest that PROMIS scores are affected by sex-based baseline differences in rTSA patients. Further study should investigate sex-based differences in baseline scores to determine their effects on ultimate outcome.
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Lai et al. (2023) conducted an observational in Shoulder arthroplasty (n=187). Female sex vs. Male sex was evaluated on Preoperative PROMIS Physical Function (PF) scores (p=<.05). Female patients undergoing reverse total shoulder arthroplasty had significantly lower preoperative PROMIS Physical Function scores compared to males, exceeding the MCID of 4 (P<.05).
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