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. 2024 Nov 22;19(1):786.
doi: 10.1186/s13018-024-05285-8.

Which patient level factors predict persistent pain after reverse total shoulder arthroplasty?

Daniela Brune  1 , Steven Z George  2 , Robert R Edwards  3 , Philipp Moroder  4 , Markus Scheibel  4   5 , Asimina Lazaridou  6   7
Affiliations

Which patient level factors predict persistent pain after reverse total shoulder arthroplasty?

Daniela Brune et al. J Orthop Surg Res. .

Abstract

Background: Reverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes.

Methods: In this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain.

Results: The cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p < 0.001), worse preoperative QuickDASH scores (β = 0.09, p = 0.002), mild symptoms of anxiety or depression (β = 0.52, p = 0.001), prior contralateral TSA surgery (β = 0.34, p = 0.018) and greater number of previous ipsilateral shoulder surgeries (β = 0.44, p < 0.001). In contrast, patients with rheumatoid arthritis (β = - 0.85, p < 0.001) or primary osteoarthritis (β = - 0.82, p < 0.001) experienced lower pain levels.

Conclusion: Our study offers important insights into the predictors of persistent postsurgical pain two years after RTSA. Key factors, including higher preoperative pain scores, poor mental health, elevated QuickDASH scores, prior contralateral TSA surgery and a history of prior ipsilateral shoulder surgeries, were identified as significant risk indicators for persistent postsurgical pain.

Keywords: Arthroplasty; Pain; Postoperative; Replacement; Shoulder.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This observational study was approved by the Ethical Committee of Canton Zürich (KEK-ZH-Nr. PB_2023-00002). All patients provided written informed consent for the use of their clinical data for research purposes. This work was performed at Schulthess Clinic in Zürich, Switzerland. Competing interests: The institution of S.G. (Duke University) has received funding from NIH/NIAMS (AR081796) to study post-operative pain following total shoulder arthroplasty. The institution of MS and PM (Schulthess Clinic) is involved in sponsored clinical research with Arthrex Inc. and Tornier Inc. (Stryker Corporation). to conduct a multi-center registry for total shoulder arthroplasty. P.M. designs arthroplasties for Arthrex Inc. and Medacta Corporate. M.S. ist consultant for Tornier Inc. (Stryker Corporation).

Figures

Fig. 1
Fig. 1
Flowchart describing sequential patient exclusion to arrive at the cohort sample for analysis. RTSA, Reverse Total Shoulder Arthroplasty; ASA, The American Society of Anesthesiologists physical status classification system; QuickDASH, Quick Disability of the Arm, Shoulder and Hand; SPADI, Shoulder Pain and Disability Index
Fig. 2
Fig. 2
Boxplot with individual data points (using jittering) for each participant for preoperative and postoperative pain
See this image and copyright information in PMC

References

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