Abstract
Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder
arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome
scores and range of motion. It is unknown whether patients' preoperative expectations
of surgery are lower in RTSA compared with aTSA. The purpose of this study was to
assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA.
Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis
or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively.
Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder
Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors
were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons
(ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE),
and patient satisfaction were obtained.
Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference
in total preoperative expectations score between groups. On multivariate linear regression
analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise.
Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score
was not correlated with postoperative functional outcomes or satisfaction in either
group. In the aTSA group, expectations for participation in exercise were positively
correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01).
Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional
outcome than those undergoing primary RTSA, both groups reported similar aggregate
preoperative expectations. Those undergoing aTSA had higher expectations for return
to exercise which was positively correlated with postoperative functional outcomes.
Level of Evidence Level II, prospective cohort study.
Keywords
expectations - reverse arthroplasty - total shoulder arthroplasty - exercise
