Risk factors associated with pain while sleeping on the affected shoulder after primary reverse shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Research
• Pain Management

Background:

• Postoperative pain, particularly when lying on the operative shoulder, is a common concern following reverse total shoulder arthroplasty (rTSA).
• Identifying factors influencing this specific type of pain is essential for managing patient expectations and improving surgical outcomes.

Purpose of the Study:

• To identify preoperative and intraoperative risk factors associated with persistent pain when lying on the operative shoulder after primary rTSA.
• To determine factors that predict satisfactory pain improvement and patient-acceptable symptomatic states post-rTSA.

Main Methods:

• Retrospective analysis of 4,235 patients undergoing primary rTSA with 1-year follow-up.
• Assessment of demographics, diagnoses, comorbidities, surgical details, and pain scores (preoperative, postoperative, and improvement).
• Logistic regression analyses to identify significant predictors of pain outcomes, using thresholds for patient-acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB).

Main Results:

• Previous shoulder surgery, tobacco use, and higher preoperative pain levels were not associated with achieving pain improvement thresholds.
• Subscapularis repair demonstrated a positive association with achieving clinically significant pain improvement thresholds.

Conclusions:

• Tobacco use, higher preoperative pain, and prior shoulder surgery are associated with poorer outcomes regarding pain when lying on the operative shoulder post-rTSA.
• Subscapularis repair is linked to better pain relief in this specific position.
• Understanding these factors aids in patient counseling regarding postoperative expectations after rTSA.