The impact of gender on outcomes following anatomic and reverse total shoulder arthroplasty

Total shoulder arthroplasty is a highly effective intervention for treating pain and dysfunction of the shoulder. Previous studies have suggested worse postoperative outcomes in women compared to men. This study aims to examine the impact of gender on pain and functional outcomes after anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).

A retrospective chart review from January 2007 to September 2022 was conducted on all-cause total shoulder replacement by 4 fellowship-trained orthopedic surgeons at a single level 1 trauma center. Demographic variables including age, gender, and race were queried. Outcomes of interest included active forward flexion, active external rotation, visual analog scale pain score, American Shoulder and Elbow Surgeons score, as well as readmission and revision rates.

Nine hundred and fifty-six total shoulder arthroplasty cases were reviewed, which included 426 aTSA (mean age 63.5 years, 50.5% female, 82.8% Caucasian) and 530 rTSAs (mean age 69.9 years, 58.5% female, 72.0% Caucasian) with an overall mean follow-up of 5.8 years. When comparing males to females in the aTSA cohort, no significant differences in range of motion emerged. Males did report significantly less pain at 6 months (0.75, P = .044). However, at most recent follow-up, pain and functional outcomes in the aTSA cohort were similar between males and females. No differences were noted for genders with respect to surgery duration (7.7 minutes, P = .153) nor for rates in postoperative readmission (0.017, P = .725) and revision (0.004, P = .824) by 1 year follow-up. When comparing males to females in the rTSA cohort, there were also no significantly different outcomes in range of motion. Additionally, while females reported more preoperative pain (1.14, P = .0064), pain and functional outcomes in the rTSA cohort were similar between males and females postoperatively.

This study shows minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar long-term results in pain relief and function. Overall, outcomes are comparable, suggesting only minor gender-specific factors.