Patient Choice Doesn't Affect Outcomes in Specialized Shoulder Arthroplasty
Background
Patients undergoing shoulder arthroplasty for conditions like osteoarthritis or rotator cuff tear arthropathy often face complex decisions regarding surgical options. One such option is ream-and-run arthroplasty, a unique procedure that preserves bone and avoids a plastic glenoid component, appealing to younger, more active patients. However, it has been unclear whether a patient's active self-selection for this specific procedure, driven by personal research or preference, influences their postoperative pain, functional recovery, or overall satisfaction compared to those recommended by a surgeon.
Results
Both patient groups demonstrated significant improvements in all measured outcomes from baseline to 2-year follow-up. The average ASES score improved by 38.2 points (from 45.1 to 83.3) in the self-selected group and 37.9 points (from 44.8 to 82.7) in the surgeon-recommended group (p<0.001 for both within-group improvements). Similarly, VAS pain scores decreased by an average of 5.5 points (from 7.1 to 1.6) in the self-selected group and 5.3 points (from 7.0 to 1.7) in the surgeon-recommended group (p<0.001 for both). Crucially, statistical analysis revealed no significant differences between the self-selected and surgeon-recommended cohorts in mean ASES scores (p=0.78), mean VAS pain scores (p=0.65), or overall patient satisfaction rates (p=0.42) at any follow-up time point. At 2 years, 91% of self-selected patients and 89% of surgeon-recommended patients reported being 'satisfied' or 'very satisfied' with their surgical outcome, a difference of only 2% that was not statistically significant.
Why It Matters
This study provides compelling evidence that patient self-selection for ream-and-run arthroplasty does not negatively influence postoperative outcomes, including pain, function, and satisfaction. This finding is significant as it supports the concept of shared decision-making in orthopedic surgery, empowering patients to actively participate in their treatment choices without concerns that their personal preference might lead to inferior results. The results suggest that surgeons can confidently engage in open discussions about specialized procedures like ream-and-run arthroplasty, knowing that a patient's informed choice is unlikely to be a determinant of their long-term success. Future research could explore patient-reported reasons for self-selection and conduct prospective studies comparing ream-and-run to other arthroplasty types in self-selected populations.