title: Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival.
abstract: BACKGROUND
  Shoulder arthroplasty in individuals aged 50 years or younger reportedly leads to worse outcomes than in older patients. Current methods of determining survivorship may be inadequate and may not reflect actual patient definitions of satisfaction. The purpose of this study is to evaluate and contrast the survival of patient satisfaction and implant survival in the youngest reported patients undergoing either a primary hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) using a third-generation stemmed prosthesis.
  
  
  METHODS
  Outcomes in 71 patients aged 50 years or younger who were treated with primary HA or TSA were evaluated for patient satisfaction and implant survival rates. Patient satisfaction survival was based on yes or no answers to 2 binary questions regarding willingness to undergo surgery again and whether surgery improved the patient's shoulder.
  
  
  RESULTS
  The Kaplan-Meier patient satisfaction survival rates at 5 years were 71.6% (95% confidence interval [CI], 46%-87%) for HAs and 95% (95% CI, 81%-99%) for TSAs. Multivariable regression analysis implicated postoperative pain as the primary causative factor for failure of patient satisfaction in all patients. In contrast, the implant survival rates at 5 years were 89% (95% CI, 69%-96%) for HAs and 95% (CI, 85%-100%) for TSAs.
  
  
  CONCLUSIONS
  Patients aged 50 years or younger who undergo shoulder arthroplasty have declining rates of self-reported satisfaction despite high implant survival rates, and this finding highlights the discordance between patient satisfaction and implant survival. Primary TSA outperforms HA in both implant survival and patient satisfaction survival rates at short-term follow-up. Future studies and registries must incorporate measurements of patient satisfaction and not just revision rates to truly interpret outcomes.
authors.affiliation: Orthopaedic Service, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: joe.eichinger@gmail.com.
authors.forename: Josef K
authors.initials: JK
authors.lastname: Eichinger
authors.affiliation: Sports Medicine & Shoulder Service, Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Miller
authors.affiliation: Beach Cities Orthopedics & Sports Medicine, Manhattan Beach, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hartshorn
authors.affiliation: Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Xinning
authors.initials: X
authors.lastname: Li
authors.affiliation: Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
authors.affiliation: Sports Medicine & Shoulder Service, Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011475:Prosthesis Failure / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D000072227:Shoulder Prosthesis; D055815:Young Adult
keywords: Shoulder arthroplasty; implant survival; patient satisfaction; young patients