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Side-to-side differences in postoperative function and patient satisfaction after bilateral total shoulder
Ashley M B Suttmiller1, Josie A Elwell2, Christopher Roche2
1Atlantic Orthopaedic Specialists, Virginia Beach, VA, USA.
Journal of Shoulder and Elbow Surgery
|March 25, 2022
Summary
Most patients experience similar outcomes after bilateral total shoulder arthroplasty (TSA). However, reverse TSA patients reported more unequal satisfaction due to functional differences between shoulders.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Patient Outcomes
Background:
- Increasing rates of anatomic and reverse total shoulder arthroplasty (TSA) lead to more staged bilateral TSA procedures.
- While bilateral TSAs improve outcomes, side-to-side clinical and satisfaction differences remain unexamined.
- Understanding these differences is crucial for setting accurate patient and provider expectations.
Purpose of the Study:
- To investigate side-to-side differences in clinical outcomes and patient satisfaction following staged bilateral total shoulder arthroplasty (TSA).
- To identify factors influencing potential discrepancies in outcomes between the dominant and non-dominant shoulders after bilateral TSA.
Main Methods:
- Utilized an international multicenter registry of patients undergoing staged bilateral TSAs (April 2007-October 2019) with ≥2-year follow-up.
- Compared American Shoulder and Elbow Surgeons (ASES) outcomes and satisfaction ratings between dominant/non-dominant and first/second operated shoulders.
- Employed regression analyses to explore factors associated with side-to-side differences in ASES scores and satisfaction.
Main Results:
- Sixty patients (22 anatomic, 38 reverse TSA) were included; most showed similar functional outcomes and satisfaction.
- Reverse TSAs significantly predicted greater side-to-side differences in postoperative ASES scores (P=.025) compared to anatomic TSAs.
- 31.6% of reverse TSA patients reported unequal satisfaction versus 9.1% of anatomic TSA patients; greater ASES differences increased likelihood of unequal satisfaction (OR 1.11, P<.001).
Conclusions:
- Bilateral TSA generally yields similar outcomes, irrespective of shoulder dominance or surgery sequence.
- Reverse TSA patients more frequently report unequal satisfaction, linked to larger functional differences between shoulders.
- Providers should counsel patients on potential functional and satisfaction disparities, particularly those undergoing reverse TSA.
