Longitudinal evaluation of patient-reported outcome measures and clinician-based scores after reverse shoulder arthroplasty in Asian patients: patient-reported outcome measures may be sufficient beyond 1 year.

BACKGROUND

Reverse total shoulder arthroplasty (rTSA) provides reliable outcomes for irreparable cuff tears and arthropathy, although most data are Western populations. Asian patients have smaller physiques, lower bone density, and greater internal rotation requirements, which may affect outcomes. Clinician-based scores (eg, Japanese Orthopedic Association [JOA] score) remain standard; however, patient-reported outcome measures (PROMs), including the American Shoulder and Elbow Surgeons (ASES) score, are increasingly adopted worldwide. Whether PROMs reflect recovery or replace clinician evaluations in Asian patients remains unclear. Accordingly, we aimed to compare PROMs and clinician-based scoring systems in Asian patients undergoing rTSA, spanning from the preoperative phase to 2 years post-operatively, and to evaluate longitudinal correlations between these measures.

METHODS

This retrospective study included 211 rTSA-treated shoulders (July 2016-March 2022). Evaluations were conducted pre-operatively and at 3, 6, 12, and 24 months using JOA, University of California, Los Angeles (UCLA), and Constant-Murley (CS) scores. The ASES score served as the PROM. Longitudinal changes were analyzed using the Friedman test and Bonferroni correction. To assess ASES utility at 2 years, receiver operating characteristic and linear regression analyses evaluated its correlation with clinician scores and prediction of favorable outcomes (JOA ≥ 83, CS ≥ 57, UCLA ≥ 28).

RESULTS

Forward flexion, abduction, and all scores (ASES, JOA, UCLA, CS) improved significantly by 1 year (P < .01), before stabilizing. External and internal rotation declined at 3 months but recovered by 2 years. ASES strongly correlated with clinician scores at 1 and 2 years (r ≥ 0.7). Receiver operating characteristic analysis confirmed high ASES predictive value (area under the curve: 0.84-0.85).

CONCLUSIONS

Most recovery after rTSA occurs within 1 year and then stabilizes. PROMs like ASES reliably assess long-term rTSA outcomes, as demonstrated in this Japanese cohort.