Does severe preoperative shoulder pain affect postoperative outcomes after reverse total shoulder arthroplasty

Background: The purpose of this study is to determine the improvement of pain and postoperative function after reverse total shoulder arthroplasty (rTSA) in patients who have severe preoperative pain. We hypothesized that these patients would have lower postoperative function and not experience the same scaled improvement as other patients. Methods: After the application of exclusion criteria, 214 patients who underwent primary rTSA in a 6-year period and had at least one year outcome data met the inclusion criteria. Age, demographics, preoperative, and 1-year postoperative pain visual analog scale (VAS) were recorded, range of motion (ROM), subjective shoulder value (SSV), and postoperative shoulder outcome scores (American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California-Los Angeles, and Constant) were collected. Additional information, such as number of patient-reported allergies, history of anxiety/depression, preoperative use of antidepressants/anxiolytics/psychotropics, and preoperative opioid usage, were also obtained. Patients were separated into two cohorts as follows: severe preoperative pain (VAS scores of 9-10, n = 114) and lower preoperative pain (VAS scores < 9, n = 110). Results: Patients with severe preoperative pain had significantly lower preoperative SSV and ROM in each category compared to the other cohort. Postoperative differences in VAS, ROM, and outcome scores were not significant between the severe preoperative pain cohort and the lower preoperative pain cohort. When examining the changes in outcomes from preoperatively to postoperatively, patients with severe preoperative pain experienced statically significant improvements in VAS, SSV, and all ROM measurements except for active external rotation. No significant differences were seen in the number of patient-reported allergies, tobacco usage, history of anxiety/depression, usage of antidepressants/anxiolytics/psychotropics, or preoperative opioid usage between the two groups. Discussion and Conclusion: This study demonstrated that patients with severe preoperative pain had significantly lower shoulder function preoperatively. However, these patients had similar outcomes after rTSA compared to other patients undergoing the same procedure who did not report severe preoperative pain. Further, these patients experience a significant increase in shoulder function and decrease in pain after rTSA compared to preoperative assessments, in contrast to other patients who did not report severe preoperative pain.