Every year more than 35,000 people in the United States have a total shoulder replacement (TSR) for painful, limiting osteoarthritis. What are these patients' expectations? Are they satisfied after surgery? And are their expectations linked with their satisfaction? These are the questions surgeons at the Hospital for Special Surgery in New York City asked 98 of their total shoulder patients.
It might seem obvious that expectations of a shoulder replacement would range from relief of pain, better sleep, improved motion, and return of daily function (e.g., ability to reach, self-care, put on a seatbelt and drive).
But with more and more younger people having this procedure, those expectations have broadened. Now expectations include ability to participate in recreational or sports activities, carry heavy objects, and full restoration of motion and function.
How well were these expectations met in this group? To find out, each patient filled out a number of different surveys measuring expectations regarding pain, motion, fatigue, general health (physical, emotional, and mental), and their goals for surgery. Demographic information about each patient was also collected including age, education level, history of previous joint replacements, and presence of other diseases, illnesses, or health problems.
As it turned out, younger patients did have higher expectations in general but especially as it concerned returning to their previous level of activity (including work) and sports. Women were more concerned about keeping the shoulder from clicking or dislocating.
Everyone expected pain relief (day and night) and improved range-of-motion. Lower physical function before surgery was also linked with greater expectations for improvements after surgery in all ages and for both sexes (men and women).
What's the benefit of this kind of information about pre-operative patient expectations of total shoulder replacement? Knowing what patients expect from this surgery gives the surgeon a chance to gear preoperative counseling toward reasonable outcomes.
Knowing that younger people expect more gives the surgeon an opportunity to address patient goals, especially as these might relate to sports activities. This finding also alerts surgeons to the fact that younger, more active patients may put greater demands on the shoulder implant. With older adults being much more active these days, patient and surgeon can discuss reasonable goals and expectations for recreational and leisure time activities.
One thing this study did not assess and that was the effect of surgeon interaction and discussion with patients. It is possible that how and what the surgeon says to the patient before surgery about the expected results could influence final outcomes and patient satisfaction. The authors suggest that further study of this factor may be helpful.
Reference: R. Frank Henn III, MD, et al. Preoperative Patient Expectations of Total Shoulder Arthroplasty. In The Journal of Bone and Joint Surgery. November 16, 2011. Vol. 93-A. No. 22. Pp. 2110-2115.