Legacy shoulder outcome measures have a postoperative ceiling impact when assessing clinical outcomes for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty patients. This study uses data from an international database of a single shoulder prosthesis from 30 different clinical sites to quantify and compare the percentage of aTSA and rTSA patients achieving postoperative ceiling scores with multiple outcome measures, as well as defines the patient demographics, comorbidities, implant, and operative parameters associated with ceiling scores for each outcome measure. The ASES, SST, UCLA, Constant, and SAS scores were used to assess clinical outcomes for 1,817 aTSA and 2,635 rTSA patients between 2007 and 2019. The number of aTSA and rTSA patients who obtained ceiling scores using the SST, ASES, and UCLA measures was calculated and compared to patients who did not attain ceiling scores. The patient demographics, comorbidities, and implant and surgical parameters linked with ceiling scores for each outcome measure were found by Researchers using univariate and multivariate analyses.

For all outcome measures except SAS, aTSA patients obtained ceiling scores at a much higher rate than rTSA patients. The SST score was the most vulnerable to ceiling scores (aTSA=43.4 %, rTSA=34.1 %, P<0.0001), followed by the ASES (aTSA=23.7 %, rTSA=13.3 %, Pp<0.0001) and UCLA (aTSA=22.2 %, rTSA=10.6 %, P<0.0001). Ceiling scores were the least likely with the Constant (aTSA=0.4%, rTSA=0%, P=0.0060) and SAS (aTSA=0.1%, rTSA=0%, P=0.0750) scores. Using the SST and ASES scores, male patients had a considerably higher ceiling score rate than female patients, but no differences in ceiling score rates were seen with the UCLA, Constant, or SAS scores. Finally, investigators discovered a slew of patient demographic, comorbidities, implant, and operational variables linked to SST, ASES, and UCLA ceiling scores in aTSA and rTSA patients. Postoperative ceiling scores are common in aTSA and rTSA patients with SST, ASES, and UCLA scores. aTSA patients treated with cage glenoids, aTSA patients with lower BMI, rTSA patients of the male gender, rTSA patients with OA diagnosis, and rTSA patients with subscapularis repair are the patients most vulnerable to ceiling scores. Alternative scores, such as the SAS score, should be considered by the clinical study team to assure a more normalized distribution of data and to measure aTSA and rTSA outcomes more properly.