Fulfillment of patients' expectations for reverse total shoulder arthroplasty for the treatment of rotator cuff tear arthropathy using the Exactech Equinoxe Platform.

BACKGROUND

Despite the increasing use of reverse total shoulder arthroplasty (rTSA), there remain limited data regarding perioperative expectations and fulfillment of expectations for patients undergoing rTSA for rotator cuff tear arthropathy (CTA). Thus, the purpose of this study was to determine the proportion of expectations that are fulfilled following rTSA and to determine which patient characteristics are associated with fulfillment of expectations at 2-year follow-up.

METHODS

Preoperatively, patients completed the Hospital for Special Surgery's Shoulder Surgery Expectation Survey, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS) for pain, and a Single Assessment Numeric Evaluation (SANE) score for the affected shoulder. At 2-year follow-up, patients were asked to what extent each of their corresponding preoperative expectations that they had previously cited as "very important" were now fulfilled, and again completed the patient-reported outcomes. Demographic and range of motion (ROM) data were also collected.

RESULTS

Seventy-seven patients met all inclusion criteria and were included in this study. The expectations most frequently cited as being "very fulfilled" postoperatively were improvement in self-care (75%), improvement in ability to drive and put on seatbelt (77%), and relief of daytime pain (73%). Eighty-one percent of patients cited improvement in shoulder ROM as an important expectation preoperatively, but only 53% reported that this expectation was "very fulfilled" postoperatively. Patients with better postoperative ASES scores (P < .001), better VAS scores (P < .001), and better SANE scores (P < .001) compared with the average patient had a greater proportion of expectations fulfilled.

CONCLUSIONS

Patients undergoing rTSA for CTA had greatest fulfillment of expectations for improvement in self-care, ability to drive, and relief of daytime pain at 2-year follow-up. Relatively few patients reported fulfillment of expectations for shoulder ROM. Better postoperative ASES, VAS, and SANE scores correlated with greater fulfillment of expectations. It is important to understand traditional objective metrics considered for success to surgeons may not be the same as a patient's perspective. Using this information, surgeons can better tailor their preoperative discussions with patients to appropriately manage expectations.