Effect Size in Surgical Intervention Into Shoulder: What Procedures Are Game Changers and What Are Not?

Abstract

A number of surgical procedures are performed to treat a variety of shoulder pathologies. What is currently not understood is which of these surgical interventions provide the most improvement in patient-reported pain and function. We aimed to determine, from a patient's perspective, which were the most effective commonly performed surgical procedures for disorders of the shoulder and which were not. This study was a retrospective analysis of prospectively collected data from patients who underwent shoulder surgery by a single surgeon. To be included, at least 20 patients needed to have undergone that procedure and completed a questionnaire evaluating their shoulders function preoperatively and 6 months postoperatively. The primary outcome was change in response to the question "how is your shoulder overall?" Effect size is reported as Cohen's <i>d</i> (standardized mean difference). Two thousand two hundred six surgical procedures in 13 categories met the inclusion criteria. All procedures were associated with improvements in the patient-ranked overall shoulder status at 6 months (<i>P</i> < 0.01 to <i>P</i> < 0.0001). Reverse total shoulder arthroplasty (RTSA) provided the greatest effect size (improvement) in the overall shoulder status (d = 3.14, 95% CI, 2.49 to 3.79), followed by total shoulder arthroplasty (d = 2.60, 95% CI, 2.10 to 3.10) and capsular release (d = 1.41, 95% CI, 1.08 to 1.75). RTSA provided the greatest effect size in patient-reported shoulder pain, whereas capsular release provided the greatest effect size in patient-reported shoulder function. Acromioclavicular joint resection (d = 1.22, 95% CI, 0.56 to 1.88) and acromioplasty (d = 1.29, 95% CI, 0.96 to 1.61) provided the least effect size overall. All shoulder surgical procedures in this study provided a notable patient-perceived therapeutic benefit in a relatively short period of time (6 months). RTSA, total shoulder arthroplasty, and capsular release are the most effective procedures. Acromioplasty and acromioclavicular resection are the least effective.