Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse...

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.