Outcomes after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty in patients with long-term disability claims

Abstract

BackgroundStudies have shown that patients with workers' compensation claims have worse clinical outcomes after various orthopedic procedures. This study aimed to determine the influence of disability status on 2-year clinical outcomes after reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA). MethodsReview of an institutional database identified patients on disability with a minimum of 2-year follow-up and compared them to a comorbidity-matched cohort of patients without disability claims. Assessments between patients included preoperative and postoperative Visual Analog Scale (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, strength, range of motion (ROM), and postoperative complications. ResultsForty-eight shoulders (45 patients) were in the ATSA cohort (24 with disability, 24 without disability) and 46 shoulders (45 patients) in the RTSA cohort (23 with disability, 23 without disability). Patients in the ATSA cohort with disability claims had higher 3-month and 2-year VAS scores (4 vs. 1, P = .003; 4 vs. 1, P = .02, respectively), lower 2-year ASES scores (58 vs. 87, P = .015), and decreased forward elevation ROM and internal rotation ROM (150 vs. 170, P = .017; 60 vs. 62.5, P = .024, respectively) compared to the cohort without disability. Significant differences in baseline values also were noted between cohorts (lower preoperative ASES: 31.7 vs. 40.5, P = .033; higher VAS: 7 vs. 6, P = .03; decreased forward elevation ROM: 90 vs. 110, P = .02). Patients in the RTSA cohort with disability claims had higher 3-month and 2-year VAS (5 vs. 1, P = .02; 3 vs. 0.5, P = .04, respectively) scores than those without claims. The baseline values for the disability cohort with RTSA demonstrated lower ASES (22.1 vs. 43.6, P = .005) and higher VAS (8 vs. 4, P = .004) scores. No significant differences were noted in improvement for the ATSA or RTSA cohorts in any parameter. The ATSA with disability cohort had a higher complication rate (45% vs. 16.6%, P = .0299). No differences were noted in complication rates in the RTSA group. ConclusionPatients who have reported disability status demonstrated worse outcomes after ATSA and RTSA compared to patients without disability claims. However, there was no significant difference in the amount of change in outcomes between groups, indicating that patients on disability can still realize significant improvements after shoulder arthroplasty.