Pain After Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty

As anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) become increasingly common, differences between the 2 procedures are of importance. The purpose of this study was to determine differences in acute pain levels between patients undergoing aTSA and rTSA. Sixty patients undergoing aTSA or rTSA were assessed for participation. The primary outcome was postoperative daily visual analog scale scores, which were initially collected for 4 days postoperatively. Secondary outcomes included opioid consumption, length of stay, and complications. Comparisons between the 2 groups were assessed using a multivariable analysis, which controlled for sex, age, body mass index, and type of anesthetic. A total of 57 patients consented and were analyzed. No significant differences were found in postoperative visual analog scale scores in the first 4 days following surgery or at 1 year postoperatively. Patients undergoing aTSA had a higher mean opioid requirement in the first 4 hours postoperatively (1.0±0.7 vs 0.4±0.6 morphine milligram equivalents, P<.01). Forty percent of patients undergoing shoulder arthroplasty were prescribed narcotics within the 3 months prior to surgery. Patients who were prescribed narcotics prior to surgery were more likely to continue to require narcotics at extended time periods postoperatively. Patients undergoing aTSA required more opioid medication in the immediate postoperative period. However, after 4 hours postoperatively, no significant differences in pain scores or opioid consumption were found. These findings suggest that patients undergoing aTSA or rTSA have similar postoperative pain profiles. Patients who are prescribed narcotics before shoulder arthroplasty are at an increased risk for postoperative opioid demand. [Orthopedics. 2019; 42(2):e247-e252.].