Abstract
BACKGROUND: Patient-reported outcome measures (PROMs) are vital for evaluating surgical outcomes. Legacy PROMs, such as the American Shoulder and Elbow Surgeons (ASES) score, have been the standard for examining upper extremity (UE) function but are not without limitations. Newer tools, such as the Patient-Reported Outcomes Measurement Information System (PROMIS) UE and Shoulder Arthroplasty Smart (SAS) score, offer potential improved sensitivity in assessing UE outcomes. The goal of this study was to assess the accuracy of both PROMIS UE and SAS to the established legacy ASES score. METHODS: A retrospective study of patients who underwent primary shoulder arthroplasty from 2020 to 2022 was analyzed for PROMs using ASES, PROMIS UE, and SAS. Pearson correlation coefficients were obtained to compare ASES with PROMIS UE as well as ASES with SAS scores from patients with a minimum of 2-year follow-up. Ceiling effect analysis was conducted using ASES, PROMIS UE, and SAS scores. RESULTS: A total of 70 patients met inclusion criteria and were analyzed. The mean final follow-up was 2.48 years. The correlation of ASES vs. PROMIS UE was noted to be excellent-good at 6-month (r = 0.647, P value < .001) and at the minimum 2-year follow-up (r = 0.761, P value < .001), respectively. When comparing ASES vs. SAS, the correlation was excellent-good, or excellent, at the 6-month, 1 year, and 2-year follow-up (r = 0.748, r = 0.738, and r = 0.688, respectively P value < .001). Ceiling effect analysis showed low ceiling effects at the 2-year minimum follow-up, with the percentage of patients achieving the maximum ASES, PROMIS UE, and SAS scores being 0.23%, 0.91%, and 0.00%, respectively. CONCLUSIONS: The present study suggests PROMIS UE and SAS are effective, shoulder-specific alternatives to legacy instruments. Both instruments showed strong, increasing correlations with ASES through 2 years follow-up and demonstrated low ceiling effects, indicating sensitivity across a broad functional range. These results highlight the clinical utility of PROMIS UE and SAS for patient-centered outcome assessment in shoulder arthroplasty populations.