Patient-reported outcomes of reverse total shoulder arthroplasty: a comparative risk factor analysis of improved versus unimproved cases

Abstract

BackgroundThe purpose of this study was to compare characteristics of patients who reported to be subjectively unimproved vs. improved after reverse total shoulder arthroplasty.MethodsData were derived from a prospective registry of patients who underwent reverse total shoulder arthroplasty with a minimum 2-year follow-up. Patients were asked to rate their subjective satisfaction and then divided into those who were unchanged or worse (unimproved group [UG]) vs. better or much better (improved group [IG]). The groups were compared for differences in demographic characteristics, preoperative factors, functional outcomes, and complications.ResultsThere were 1425 patients in the IG and 134 patients in the UG. Patients in the IG were more likely to have a diagnosis of osteoarthritis. Patients in the UG were more likely to have coronary artery disease and diabetes and to have undergone prior surgery. No differences in implant configuration were found between groups. Preoperative measures for patients in the UG were worse for pain and function but not for range of motion. The outcomes in patients in the UG were worse for all postoperative measures, as well as for preoperative-to-postoperative improvement. Of the patients in the UG, 48% continued to have moderate to severe pain postoperatively. The complication rate was significantly higher in the UG.DiscussionUp to 8.5% of patients rate themselves as unimproved after surgery. These patients are more likely to have certain comorbidities and to have undergone prior surgery. Although outcomes were significantly worse for all measures in the UG, improvement occurred in all measures despite patients subjectively being worse or unchanged. Residual pain and difficulty sleeping play a substantial role in subjective assessment of overall outcome.

Influence of Thoracic Kyphosis on Reverse Total Shoulder Arthroplasty Outcomes

“…The improved group had a mean increase in shoulder forward elevation of 55.5° and abduction of 47.4° compared with the unimproved group who had an increase in forward elevation of 26.0° and abduction of 20.6°. 7 Our population demonstrated a global increase in shoulder ROM postoperatively, which was not influenced by thoracic kyphosis. Comparatively, patients with kyphosis <25°, between 25 and 45°, and >45° had an increase in shoulder forward elevation of 47.5°, 44.5°, and 46.4°, respectively.…”

“…[1][2][3][4][5][6] Dissatisfaction rates after primary rTSA for degenerative conditions and rotator cuff pathology reach up to 9%. 7 Risk factors for patient dissatisfaction after rTSA include decreased preoperative shoulder range of motion (ROM), lower preoperative patient-reported outcome measures (PROM), history of previous shoulder surgery, history of coronary artery disease or diabetes, and tobacco use. [7][8][9][10] Although many of these risk factors are nonmodifiable, surgeons can incorporate known risk factors into preoperative counseling to manage patient expectations.…”

“…7 Risk factors for patient dissatisfaction after rTSA include decreased preoperative shoulder range of motion (ROM), lower preoperative patient-reported outcome measures (PROM), history of previous shoulder surgery, history of coronary artery disease or diabetes, and tobacco use. [7][8][9][10] Although many of these risk factors are nonmodifiable, surgeons can incorporate known risk factors into preoperative counseling to manage patient expectations. Preoperative education is important to help guide patients in what to expect after rTSA and help them make the appropriate choice to pursue surgery.…”

Strength Assessment After Reverse Shoulder Arthroplasty

“…There is a concern in the literature about identifying the factors that influence the final result of RSA. Parsons et al 8 found that approximately 9% of patients who underwent primary RSA were dissatisfied with the result and that these cases were usually related to comorbidities, such as coronary disease, diabetes, and previous shoulder surgery.…”

“…Regarding the functional outcome, Parsons et al 8 looked for risk factors for failure after RSA. They found that patients with coronary heart disease, diabetes and previous joint surgery were more likely to have worse functional outcomes, although they were not correlated with the pre-operative expectations of these patients.…”