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. 2024 Nov 22;13(1):286.
doi: 10.1186/s13643-024-02694-y.

Patient-related prognostic factors for function and pain after shoulder arthroplasty: a systematic review

Brechtje Hesseling  1   2 , Nisa Prinsze  3 , Faridi Jamaludin  4 , Sander I B Perry  3 , Denise Eygendaal  5 , Nina M C Mathijssen  6 , Barbara A M Snoeker  3   7
Affiliations

Patient-related prognostic factors for function and pain after shoulder arthroplasty: a systematic review

Brechtje Hesseling et al. Syst Rev. .

Abstract

Background: While shared decision making is a cornerstone of orthopedic care, orthopedic surgeons face challenges in tailoring their advice and expectation management to individual shoulder arthroplasty patients due to the lack of systematically summarized evidence-based knowledge. This systematic review aims to provide an overview of current knowledge on independent predictive effects of patient-related factors on functional and pain-related outcomes after shoulder arthroplasty.

Methods: We included longitudinal cohort studies including patients receiving total or reverse shoulder arthroplasty or hemiarthroplasty for primary osteoarthritis or cuff tear arthropathy. Studies with only univariable analyses were excluded. MEDLINE, Embase, and CINAHL databases were last searched on June 27, 2023. Risk of bias was evaluated using the QUIPS tool. For the analyses, we divided outcomes into three domains (Functional Recovery, Pain, and Functional Recovery & Pain) and four time points (short term, medium-short term, medium-long term and long term). When appropriate, meta-analyses were conducted to pool regression coefficients or odds ratios. Otherwise, results were summarized in a qualitative analysis. We used the GRADE approach to rate the certainty of the evidence.

Results: Thirty-three studies analyzing over 6900 patients were included; these studied 16 PROMs and 52 prognostic factors. We could perform meta-analyses for six combinations of prognostic factor, domain, and time point. Only the meta-analysis for medium-long term poor ASES scores indicated worse outcomes for previous shoulder surgery (OR (95%CI) of 2.10 (1.33-3.33)). The majority of reported factors showed unclear or neutral independent effects on functional outcomes.

Conclusions: Methodological heterogeneity and selective/incomplete reporting prevented us from pooling most results, culminating in a largely qualitative analysis. Depression, preoperative opioid use, preoperative ASES and SST scores, surgery on the dominant side, previous surgery, male gender, no. of patient-reported allergies, back pain, living alone, CTA vs OA, diabetes, and greater preoperative external ROM predicted neutral to worse or worse outcomes. In contrast, higher electrical pain threshold on the operative side, OA/RCA vs other diagnosis, and private insurance vs Medicaid/Medicare predicted neutral to better or better outcomes. These results can help orthopedic surgeons tailor their advice and better manage expectations.

Systematic review registration: PROSPERO CRD42021284822.

Keywords: Functional recovery; PROMs; Pain; Prognostic factor; Shoulder arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias overview
Fig. 3
Fig. 3
Meta-analysis results for prognostic factor "age" on raw ASES scores, medium-short term
Fig. 4
Fig. 4
Meta-analysis results for prognostic factor "gender" on raw ASES scores, medium-long term
Fig. 5
Fig. 5
Meta-analysis results for prognostic factor "age" on raw ASES scores, medium-long term
Fig. 6
Fig. 6
Meta-analysis results for prognostic factor "Walch A2 vs A1" on raw ASES scores, medium-long term
Fig. 7
Fig. 7
Meta-analysis results for prognostic factor "Previous surgery" on raw ASES scores, medium-long term
Fig. 8
Fig. 8
Meta-analysis results for prognostic factor "Previous surgery" on the odds of achieving poor ASES scores, medium-long term
Fig. 9
Fig. 9
Summary of Findings for the domain "Functional Recovery & Pain", medium-short term
Fig. 10
Fig. 10
Summary of Findings for the domain "Functional Recovery", medium-short term
Fig. 11
Fig. 11
Summary of Findings for the domain "Pain", medium-short term
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