Factors associated with poor outcomes for female patients undergoing total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Patient Outcomes Research

Background:

• Gender disparities in total shoulder arthroplasty (TSA) outcomes are documented, with female patients often experiencing inferior results.
• The specific factors contributing to these poorer outcomes in women remain unclear.
• This study aimed to identify demographic and clinical differences between female TSA patients with superior versus inferior outcomes.

Purpose of the Study:

• To determine factors associated with better and worse outcomes in female patients undergoing total shoulder arthroplasty (TSA).
• To identify demographic, clinical, and surgical variables that predict patient satisfaction and functional recovery after TSA in women.
• To inform patient counseling and surgical decision-making for female TSA patients.

Main Methods:

• A retrospective review of 409 female patients undergoing primary anatomic (aTSA) or reverse (rTSA) total shoulder arthroplasty between 2016 and 2022.
• Patients were stratified based on achieving a Patient Acceptable Symptom State (PASS) defined by a Single Assessment Numeric Evaluation (SANE) score of 75% at two years postoperatively.
• Univariate and multivariate regression analyses were used to compare demographic factors, surgical indications, preoperative range of motion, and postoperative outcome scores (VAS pain, ASES function, ASES total, satisfaction).

Main Results:

• 64.5% of female patients achieved PASS, demonstrating significantly superior outcome scores compared to those who did not.
• Factors negatively associated with achieving PASS included undergoing reverse TSA (rTSA) and having prior ipsilateral shoulder surgery.
• Never smoking was positively associated with achieving PASS, and the ability to perform tasks like combing hair, reaching high shelves, and usual work were highly predictive of achieving PASS.

Conclusions:

• Smoking, prior shoulder surgery, and undergoing reverse TSA are independently associated with inferior outcomes in female TSA patients.
• Patient counseling and decision-making should incorporate these factors.
• Postoperative expectations should be managed, as female patients' satisfaction is strongly linked to regaining shoulder range of motion for overhead activities.