Aims A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness. Methods Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023. A total of 390 patients (mean follow-up 48.1 months (SD 42.0)) were included: 97 (24.9%) were classified as appropriate, 218 (55.9%) inconclusive, and 75 (19.2%) inappropriate. Patients were classified as "appropriate", "inconclusive", or "inappropriate", using a modified version of an appropriateness algorithm, which accounted for age, rotator cuff status, mobility, symptomatology, and Walch classification. Multiple pre- and postoperative scores were analyzed using Pearson's chi-squared test and one-way analysis of variance (ANOVA). Postoperative complications were also analyzed. Results All groups achieved significant improvement in mean PROM scores postoperatively. "Appropriate" patients experienced significantly greater improvement in visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score compared to "inconclusive" and "inappropriate". The appropriate group had a significantly greater proportion of patients who achieved minimal clinically important difference (MCID) (95.8%; n = 93) and substantial clinical benefit (SCB) (92.6%; n = 89). Overall, 13 patients had postoperative complications. No significant differences in postoperative complications among classifications were found. Conclusion Our data clinically validate the RAND/UCLA aTSA appropriateness criteria algorithm, allowing for more rapid and reliable determination of aTSA candidacy. "Appropriate" patients were more likely to achieve MCID and SCB for ASES scores compared to "inappropriate" patients. Among "appropriate" patients who did not achieve SCB, 50% (n = 4) had a postoperative complication. There was a significantly higher proportion of postoperative complications among those who did not achieve SCB across all three groups. Only 7.1% (n = 1) of patients who did not achieve SCB in the inappropriate group had a postoperative complication. Thus, it can be inferred that the failure to reach SCB in the appropriate group was likely to be due to a postoperative complication, whereas for patients deemed "inappropriate", failure to reach SCB may be secondary to factors accounted for within our algorithm.

中文翻译：

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临床结果验证了解剖全肩关节置换术的 RAND/UCLA 适当性标准算法，以简化临床决策过程。


目的 最近的一项研究使用加州大学洛杉矶分校 RAND Corporation （RAND/UCLA） 方法制定解剖全肩关节置换术 （aTSA） 适宜性标准。我们研究的目的是确定患者报告的结果测量 （PROM） 如何根据适当性而变化。方法 来自多中心数据库的临床数据确定了 2004 年 11 月至 2023 年 1 月接受原发性 aTSA 的患者。共纳入 390 例患者 （平均随访 48.1 个月 （SD 42.0））： 97 例 （24.9%） 被归类为适当，218 例 （55.9%） 不确定，75 例 （19.2%） 不合适。使用适当性算法的修改版本将患者分类为“适当”、“不确定”或“不适当”，该算法考虑了年龄、肩袖状态、活动能力、症状和 Walch 分类。使用 Pearson 卡方检验和单因素方差分析 （ANOVA） 分析多个术前和术后评分。还分析了术后并发症。结果 各组术后 PROM 平均评分均有显著改善。与“不确定”和“不适当”相比，“适当”患者在视觉模拟量表 （VAS） 和美国肩肘外科医生 （ASES） 评分方面的改善显著更大。适当组达到最小临床重要差异 （MCID） （95.8%;n = 93） 和实质性临床获益 （SCB） （92.6%;n = 89） 的患者比例显著更高。共 13 例患者出现术后并发症。未发现不同分类的术后并发症存在显著差异。 结论我们的数据在临床上验证了 RAND/UCLA aTSA 适当性标准算法，可以更快速、更可靠地确定 aTSA 候选资格。与“不适当”患者相比，“合适”患者更有可能达到 ASES 评分的 MCID 和 SCB。在未达到 SCB 的“适当”患者中，50% （n = 4） 出现术后并发症。在所有三组中，未达到 SCB 的患者术后并发症比例显著更高。在不适宜组中，只有 7.1% （n = 1） 未达到 SCB 的患者出现术后并发症。因此，可以推断出适当组未能达到 SCB 可能是由于术后并发症，而对于被认为“不合适”的患者，未能达到 SCB 可能是继发于我们算法中考虑的因素。