Early outcomes of shoulder arthroplasty according to sex

Abstract

Hypothesis Among patients undergoing shoulder arthroplasty (SA), female patients would have worse outcomes than their male counterparts. Methods A multicenter prospective cohort of 2364 patients (1365 female and 999 male patients) treated with total SA or reverse total SA from 2007 to 2015 was retrospectively analyzed. Results were assessed using several validated outcome measures and range-of-motion testing. A multivariable analysis identified differences in preoperative values, postoperative values, and preoperative-to-postoperative improvements while adjusting for possible confounders. Results The mean follow-up period was 45.9 ± 23.7 months in female patients and 46.4 ± 23.6 months in male patients. Women underwent SA at a significantly older age (70.8 ± 8.4 years) than men (67.6 ± 8.8 years, P < .01) and began with lower preoperative outcome scores and range-of-motion measurements: American Shoulder and Elbow Surgeons score ( P < .01), Constant score ( P < .01), Simple Shoulder Test score ( P < .01), active abduction ( P < .01), forward flexion ( P < .01), and external rotation ( P = .02). Postoperatively, both groups showed significant improvement. When we evaluated overall improvement from preoperative values, female patients showed increased improvements in the American Shoulder and Elbow Surgeons score ( P = .04) and Simple Shoulder Test score ( P < .01), as well as active forward elevation ( P < .01) and external rotation ( P = .02). However, the difference in improvements did not reach the minimal clinically important difference. Women had a higher incidence of component loosening ( P = .03) and periprosthetic fractures due to falls ( P = .01), whereas men showed a higher incidence of periprosthetic joint infections ( P < .01). Conclusion This study found that female patients undergo SA at an older age and begin with worse shoulder range of motion and outcome scores than male patients. Although women experienced a greater improvement postoperatively in outcome scores and range of motion, this improvement did not reach the minimal clinically important difference. These findings suggest that male and female patients can expect similar improvements in function after undergoing SA; however, the incidence of complications may vary depending on sex.

Gender Influences on Shoulder Arthroplasty

“…In contrast, Okoroha et al recently reported significantly lower preoperative clinical outcome scores (ASES, Constant, Simple Shoulder Test (SST), p < 0.01) in female patients compared to male patients undergoing TSA and RTSA. This study also described decreased range of motion in female patients preoperatively, specifically decreased active abduction ( p < 0.01), forward flexion ( p < 0.01), and external rotation ( p = 0.02) [ 17 ••]. In a retrospective review of an international multicenter database of 660 patients undergoing RTSA, Friedman et al similarly found lower preoperative clinical outcome scores for female patients (SST, ASES, Shoulder Pain and Disability Index (SPADI), and Constant, p < 0.001) as well as more limited motion in abduction ( p = 0.001) and passive external rotation ( p < 0.001) [ 19 ••].…”

“…These factors include patient age at presentation, preoperative disability level, and preoperative patient expectations. Female patients typically undergo shoulder arthroplasty at an older age compared to male patients [ 16 , 17 ••]. In a recent study, Okoroha et al reported an average age at time of TSA and RTSA in female versus male patients of 71.2 ± 8.5 years versus 67.4 ± 8.9 years ( p < .01) [ 17 ••].…”

“…Female patients typically undergo shoulder arthroplasty at an older age compared to male patients [ 16 , 17 ••]. In a recent study, Okoroha et al reported an average age at time of TSA and RTSA in female versus male patients of 71.2 ± 8.5 years versus 67.4 ± 8.9 years ( p < .01) [ 17 ••]. Jawa et al showed a similar trend in patients undergoing TSA as female patients had a mean age of at time of surgery of 66.4 years versus 60.8 years for male patients ( p = 0.01) [ 16 ].…”

“…In contrast to these studies, Okoroha et al did not find an association between female sex and increased length of stay following shoulder arthroplasty [ 17 ••]. Wong et al similarly found no difference in length of stay between female and male patients after RTSA (men, 2.32 days; women, 2.58 days; p = 0.18) [ 18 ••].…”

“…Additionally, both cohorts showed significant postoperative improvement in all outcome measures. Yet, compared to male patients undergoing shoulder arthroplasty, female patients started and ended with lower outcome scores and range of motion [ 17 ••]. Furthermore, male sex has been associated with better outcome scores and ROM for all measurements except external rotation after RTSA [ 19 ••].…”