Patient Education for innovative technology in shoulder arthroplasty: does knowledge improve outcomes?

As technologies such as three-dimensional pre-operative planning, navigation, and augmented or mixed reality become integral to total shoulder arthroplasty (TSA), their influence on patient perception and satisfaction remains unclear. While patient education has been shown to improve understanding and acceptance of innovation in hip and knee arthroplasty, comparable findings in shoulder surgery are limited. Previous work by this author group demonstrated that pre-operative education improves patient confidence and perception of both their surgeon and intervention. This study evaluated whether these improved perceptions about surgical technology via pre-operative education independently impacted clinical outcomes (patient-reported outcome measures (PROMs), range of motion [ROM]) following primary TSA.

We conducted a prospective cohort study of 154 patients undergoing primary TSA by a single surgeon between 2021 and 2024. Patients were assigned to an intervention group (video group, VG; n = 80) or a control group (no video group, NVG; n = 74). The intervention group viewed a 3-min surgeon-narrated video describing innovative technologies used in shoulder arthroplasty surgery. Pre- and post-video surveys assessed understanding, perceptions, and confidence in the surgeon. Clinical outcomes, including ROM and PROMs (American Shoulder and Elbow Surgeons, Subjective Shoulder Value, Penn), were collected at 6 weeks, 3, 6, and 12 months. Differences between groups were analyzed using t-tests, Mann-Whitney U tests, and Fisher exact tests, with paired tests for within-group changes.

A total of 154 patients (mean age 69 ± 9 years; 45% women) were included. Baseline demographics and pre-operative function were comparable between groups. Baseline characteristics were comparable between groups. The educational video significantly increased confidence in the surgeon (95.5%-97.6%, P= .034) and improved expectations for better results (P= .003), fewer complications (P< .001), less pain (P= .001), and faster recovery (P< .001). However, there were no significant differences in post-operative ROM or PROMs between groups at any time point (all P> .05).

Pre-operative education about surgical technology enhances patient confidence and optimism but does not independently influence functional recovery or satisfaction after TSA. While previously established that educational interventions improve patient experience, they do not independently alter clinical outcomes. Incorporating structured, interactive education may further strengthen patient engagement as technology becomes increasingly central to shoulder arthroplasty.