Background & Aims

Total shoulder arthroplasty (TSA) is effective in reducing pain and restoring function. Although most patients experience relief after surgery, a subset of patients still experience persistent postsurgical pain, often with no apparent correlation with functional or imaging findings. The main objective of this study was to determine the prevalence and factors affecting pain perception and chronic postoperative pain (CPSP) two years following reverse TSA (rTSA).

Methods

This was a retrospective cohort study using data from a local registry in a Swiss orthopedic clinic. Patients undergoing rTSA between August 2014 and May 2022 with complete baseline, operative and 24-month follow-up data were included in the final analysis. Of of the 2’595 records of rTSA surgeries performed, a total of 131 patients were excluded due to revision surgery, 262 due to duplicate registry entries and 1’510 due to missing data. The primary outcome was CPSP and defined as persistent pain with a score of 3 or higher on the pain Numeric Rating Scale (NRS). Secondary outcomes included patient-related and sociodemographic covariates, baseline mental health status, disease-related covarites and indexes of active range of motion. Multiple ordinary least squares (OLS) regression was performed to assess the associations between multiple factors and CPSP two years after surgery.

Results

A total of 692 patients (62% women) with a mean age of 73 ± 8 years at the time of surgery were included in the final analysis. Two years after rTSA, 114 patients (16%) experienced CPSP. The mean preoperative pain score on the Numerical Rating Scale (NRS) was 6 ± 3, while the mean postoperative pain score was 1 ± 2. Results of the multivariate linear regression model revealed risk factors for CPSP to be bilateral TSA (β = 0.35; 95% CI [0.05 – 0.64], higher preoperative Numeric Rating Scale (NRS) pain (β = 0.10, 95% CI [0.04 – 0.16], p = .001) and QuickDASH scores (β = 0.02, 95% CI [0.02 – 0.03], p < .001), high number of previous shoulder surgeries (β = 0.38, 95% CI [0.16 – 0.59], p = .001), higher levels of anxiety or depression (β = 0.26, 95% CI [0.02 – 0.5], p = .034). Compared to cuff tear arthropathy, a primary diagnosis of rheumatoid arthritis (beta = -0.76, 95% CI [-1.29 – -0.23], p = 0.005) and primary osteoarthritis (beta = -0.92, 95% CI [-1.17 – -0.67], p < 0.001) emerged as protective factors for postoperative pain. The overall model, adjusted for sex and age, explained 20% of the variance in postoperative pain (R2 = 0.2022).

Conclusions

This study reported on the CPSP rate and evaluated predictive factors two years after rTSA surgery. These findings augment our understanding of potential factors predicting postoperative pain persisting up to two years post TSA surgery. In addition, these results serve as the basis for identifying high-risk individuals thereby informing and optimizing treatment strategies and preoperative planning.

References

1.Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L. Persistent pain is common 1-2 years after shoulder replacement. Acta Orthop. 2015;86(1):71-77.
2.Puzzitiello RN, Menendez ME, Moverman MA, Mahendraraj KA, Jawa A. Prevalence and predictors of persistent pain 2 years after total shoulder arthroplasty. Seminars in Arthroplasty: JSES. 2021;31(1):23-29.
3.Marzel A, Schwyzer HK, Kolling C, et al. The Schulthess local Shoulder Arthroplasty Registry (SAR): cohort profile. BMJ Open. 2020;10(11):e040591.
4.George SZ, Bolognesi MP, Bhavsar NA, Penrose CT, Horn ME. Chronic Pain Prevalence and Factors Associated With High Impact Chronic Pain following Total Joint Arthroplasty: An Observational Study. J Pain. 2022;23(3):450-458.

Presenting Author

Daniela Brune

Poster Authors

Daniela Brune

Bsc. Psychology

Schulthess Klinik

Lead Author

Steven Z. George

PT, PhD

Departments of Orthopedic Surgery and Population Health Sciences, Duke Clinical Research Institute, Duke School of Medicine

Lead Author

Robert R. Edwards

PhD

Department of Anesthesiology, Brigham & Women's Hospital and Harvard Medical School

Lead Author

Philipp Moroder

MD, PhD

Department for Shoulder and Elbow Surgery, Schulthess Clinic

Lead Author

Markus Scheibel

MD PhD

Department for Shoulder and Elbow Surgery, Schulthess Clinic

Lead Author

Asimina Lazaridou

PhD

Teaching, Research and Development Upper Extremities & Hand, Schulthess Clinic

Lead Author

Topics

  • Models: Musculoskeletal