Patients over 70 years old have subclinical or impending rotator cuff dysfunction, raising concern about TSA in this population. The purpose of this study is to examine whether reverse total shoulder arthroplasty (RTSA) should be considered for the treatment of glenohumeral osteoarthritis in the presence of an intact rotator cuff (GHOA+IRC in patients older than 70 years of age.

Twenty-five elderly (>70 years) patients at least one year status-post RTSA for GHOA+IRC were matched via age, sex, body mass index, smoking status, and whether the procedure involved the dominant extremity with 25 GHOA+IRC patients who received anatomic total shoulder arthroplasty (TSA). Standardised outcome measures, range of motion, and treatment costs were compared between the two groups. Treatment cost was assessed using implant and physical therapy costs as well as reimbursement.

Patients who received RTSA for GHO+IRC had significantly lower pre-operative active forward elevation (AFE, 69° vs. 98°, p <0.001) and experienced a greater change in AFE (p=0.01), but had equivalent AFE at final follow-up (140° vs. 142°, p=0.71). Outcomes were otherwise equivalent between groups with no differences. In both those patients who underwent TSA and those that underwent RTSA, significant improvements between pre-operative and final follow-up were seen in all standardised outcome measures and in AFE (p<0.001 in all cases). RTSA provided these outcomes at a cost savings of $2,025 in Medicare reimbursement due to decreased physical therapy costs.

In patients over the age of 70 with GHOA+IRC, RTSA provides similar improvement in clinical outcomes to TSA at a reduced cost while avoiding issues related to the potential for subclinical or impending rotator cuff dysfunction.

Purpose: Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe post-operative pain. Utilizing a multi-modal pain management protocol, a blinded, randomized, placebo-controlled study was designed to evaluate the efficacy of patient selected music on reducing perceived pain.

Method: Using a standardized intra-operative anesthetic protocol and postoperative pain management protocol, consented patients were randomized into either: 1) the interventional Music group (noise-reduction headphones, patient choice/classical music) or the control, Non-Music group (noise-reduction headphones only). Pain scores, aided by the Wong-Baker and Verbal Descriptor scales, were assessed via the Visual Analog Scale (VAS) at baseline and postoperatively at 3, 6, and 24 hours. A paired Student’s t-test was utilized to determine statistical significance, which was set at a p < 0.05.

Results: Thirty subjects were enrolled. At baseline, there were no statistical differences in mean pain between the study (2.29 ± 2.78) and the control (3.34 ± 2.67) groups (p = 0.19). Mean pain scores reported the Music group to have significantly less pain at 3 hours (1.49 ± 1.39 vs. 3.87 ± 3.44, p = 0.01), and at 24 hours (2.41 ± 1.67 vs. 4.03 ± 2.89, p=0.04).

Conclusion: Intraoperative music provides an inexpensive, non-invasive method of lowering perceived postoperative pain for patients undergoing a TKA. The results of this study offer a glimpse into how an alternative therapy or non-pharmacologic method can reduce postoperative pain. A larger-scale, higher powered trial may demonstrate how music could favorably affect secondary outcomes such as patient satisfaction, range of motion, and length of stay.