Disease diagnosis and arthroplasty type are strongly associated with short-term postoperative patient-reported outcomes in patients undergoing primary total shoulder arthroplasty

Abstract

BackgroundPrognostic factors for total shoulder arthroplasty (TSA) clinical outcomes are incompletely understood. This study investigates the associations of preoperative patient, disease-specific, and surgical factors with one-year postoperative PENN Shoulder Score (PSS) in patients undergoing primary TSA. MethodsCleveland Clinic patients undergoing primary anatomic TSA (aTSA) or reverse TSA (rTSA) for glenohumeral osteoarthritis (GHOA) or rotator cuff tear arthropathy (CTA) between February 2015 and August 2019, and having complete preoperative and one-year postoperative patient reported outcome measures (PROMs), were included. Twenty preselected preoperative patient and disease-specific/surgical factors were used to fit multivariable models for one-year PSS and its subscores. Results1,174 of 1,427 eligible primary TSAs had one-year follow-up by PROMs (82%), with 1,042 analyzed after additional exclusions, including 30% rTSAs for CTA (n=308), 26% rTSAs for GHOA (n=275), and 44% aTSAs for GHOA (n=459). All PROMs showed statistically significant improvements postoperatively, with 89% of patients reaching an acceptable symptom state. Lower one-year PSS was associated with younger age, female sex, current smoking, chronic pain diagnosis, history of prior surgery, worker’s compensation claim, lower preoperative mental health, lower baseline PSS, absence of glenoid bone loss, and diagnosis-arthroplasty type (CTA-rTSA<GHOA-rTSA<GHOA-aTSA). The most important prognostic factors associated with one-year PSS were diagnosis-arthroplasty type, baseline mental health status, and insurance status. ConclusionsDisease diagnosis, arthroplasty type, and several other baseline factors are strongly and individually associated with PROMs following primary TSA, with patients undergoing aTSA for GHOA demonstrating the highest PROMs at one-year follow-up. Patient, disease-specific, and surgical factors can be used to guide postoperative prognosis following primary TSA for improved preoperative patient counseling regarding expected outcomes of these procedures.