Inferior outcomes and higher complication rates after shoulder arthroplasty in workers' compensation patients

Abstract

Outcomes of shoulder surgery in workers' compensation (WC) patients have generally been inferior to those in non-WC patients. The purpose of this study was to compare the complication rates and clinical outcomes after shoulder arthroplasty in WC patients and control non-WC patients. An institutional shoulder arthroplasty database was queried for patients with minimum 2-year follow-up who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty. WC patients were age and sex matched with non-WC patients and retrospectively evaluated for complication rates, patient-reported outcome (PRO) scores, and range of motion. We matched 45 WC and 45 non-WC patients by age and sex, with the WC group having a higher rate of prior surgery (82% vs 38%, P < .001). Both groups experienced significant improvements in all PROs, forward elevation, and external rotation (P < .05 for all). The WC group had inferior 2-year outcomes for all PROs and forward elevation (P ≤ .001 for all), as well as a higher reoperation rate (16% vs 2%, P = .030) and higher rate of persistent pain at final follow-up (33% vs 11%, P = .021). On multivariate regression controlling for other variables including number of prior surgical procedures, WC status remained associated with lower improvements in American Shoulder and Elbow Surgeons (P < .001), functional (P < .001), and Simple Shoulder Test (P < .001) scores, as well as a higher reoperation rate (P = .015) and higher rate of persistent pain (P = .027). Although both WC and non-WC patients experienced significant clinical improvements after shoulder arthroplasty, WC patients had a higher reoperation rate, inferior PROs, and a higher rate of persistent pain.