Preoperative patient expectations of elective reverse shoulder arthroplasty

R. C. Rauck
I. Swarup
B. Chang
J. J. Ruzbarsky
D. M. Dines, Zucker School of Medicine at Hofstra/Northwell
R. F. Warren
R. F. Henn
L. V. Gulotta

Abstract

© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees Background: The purpose of this study was to determine patients’ preoperative expectations before primary elective reverse shoulder arthroplasty (RSA). We hypothesized that younger patients, patients with better preoperative function, patients with shoulder osteoarthritis (OA), and patients with no prior joint replacements would have higher expectations of RSA. Methods: We prospectively studied 333 primary RSAs performed for cuff tear arthropathy (n = 242), OA (n = 68), or post-traumatic arthritis (n = 23). Expectations were assessed preoperatively using the Hospital for Special Surgery's shoulder surgery expectations survey. Preoperative patient-reported measures were assessed with the American Shoulder and Elbow Surgeons shoulder score; Shoulder Activity Scale score; Short Form 12 mental component and physical component scores; and visual analog scale scores for pain, fatigue, and general health. A Poisson regression model was performed to control for potential confounding variables. Results: Relief of night-time pain, relief of daytime pain, improvement in self-care, improvement in the ability to drive or put on a seat belt, and improvement in the ability to perform daily activities were reported as “very important” by approximately half of patients. No association was found between age and overall expectations. Multivariate analysis showed that better preoperative Shoulder Activity Scale and Short Form 12 physical component scores were associated with greater expectations (P <.001). OA was associated with greater expectations compared with cuff tear arthropathy (P <.001). A history of either contralateral RSA or any joint replacement was associated with lower expectations (P <.001). Conclusion: Patients have the highest expectations for pain relief and the performance of simple tasks after RSA. Patients with higher preoperative function, OA, and no previous joint replacements have greater expectations of RSA.