ABSTRACT
Some surgeons are reluctant to perform a reverse total shoulder arthroplasty (RTSA) on both shoulders because of concerns regarding difficulty with activities of daily living post-operatively as a result of limited rotation of the shoulders. Nevertheless, we hypothesised that outcomes and patient satisfaction following bilateral RTSA would be comparable to those following unilateral RTSA. A single-surgeon RTSA registry was reviewed for patients who underwent bilateral staged RTSA with a minimum follow-up of two years. A unilateral RTSA matched control was selected for each shoulder in those patients undergoing bilateral procedures. The Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Values (SSV), visual analogue scale (VAS) for pain, range of movement and strength were measured pre- and post-operatively. The mean CMS, ASES, SSV, VAS scores, strength and active forward elevation were significantly improved (all p < 0.01) following each operation in those undergoing bilateral procedures. The mean active external rotation (p = 0.63 and p = 0.19) and internal rotation (p = 0.77 and p = 0.24) were not significantly improved. The improvement in the mean ASES score after the first RTSA was greater than the improvement in its control group (p = 0.0039). The improvement in the mean CMS, ASES scores and active forward elevation was significantly less after the second RTSA than in its control group (p = 0.0244, p = 0.0183, and p = 0.0280, respectively). Pain relief and function significantly improved after each RTSA in those undergoing a bilateral procedure. Bilateral RTSA is thus a reasonable form of treatment for patients with severe bilateral rotator cuff deficiency, although inferior results may be seen after the second procedure compared with the first.
Subject(s)
Arthroplasty, Replacement/methods , Joint Diseases/surgery , Shoulder Joint/surgery , Activities of Daily Living , Aged , Arthroplasty, Replacement/rehabilitation , Case-Control Studies , Female , Humans , Joint Diseases/physiopathology , Joint Diseases/rehabilitation , Male , Middle Aged , Patient Satisfaction , Postoperative Care/methods , Preoperative Care/methods , Range of Motion, Articular/physiology , Shoulder Joint/physiology , Treatment OutcomeABSTRACT
Increasing concern about productivity in hospitals led to this study of the amount of time social workers typically spend with and in behalf of hospitalized patients. Among the variables the authors studied, the patient's demographic characteristics had little explanatory power, whereas psychosocial acuity, or need for services, and the types of services delivered were the best predictors of the amount of social work time expended in the patient's behalf.
Subject(s)
Efficiency , Models, Theoretical , Social Work , Task Performance and Analysis , Time and Motion Studies , Hospital Bed Capacity, 500 and over , Humans , Inpatients , Ohio , Probability , Social Work Department, HospitalABSTRACT
The efficient use of health care resources requires that patients remain in in-patient facilities only as long as is necessary. High-quality patient care requires that patients are physically, socially and psychologically prepared for leaving the hospital and that plans for their post-hospital care are adequate. The authors discuss a study of Orthopaedic patients which demonstrates that early and comprehensive social work intervention can reduce the length of time patients stay in the hospital. They also describe the effect of the study on expanding the role of social work within the acute care, general hospital.
