Preoperative Patient Expectations of Total Shoulder Arthroplasty

Background: Very little data exist regarding patients' preoperative expectations of the outcome of total shoulder arthroplasty. We hypothesized that younger patients and patients with worse function and worse general health would have greater expectations of total shoulder arthroplasty. Methods: Ninety-eight patients who underwent unilateral primary total shoulder arthroplasty at one institution were studied prospectively. The preoperative evaluation included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Scale, Short Form-36 (SF-36), and visual analog scale scores for shoulder pain, fatigue, and general health. Expectations were evaluated with use of the Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Results: Relief of daytime pain, relief of nighttime pain, and improvement of shoulder range of motion were very important to 86%, 82%, and 84% of the patients, respectively. Expectations were not associated with education, history of previous joint replacement, or comorbidities. Greater expectations were associated with younger age, worse general health on the visual analog scale, and worse ASES scores (p < 0.05 for all), with correlation coefficients ranging from 0.25 to 0.28. Multivariate analysis showed that younger age was the only independent predictor of greater expectations (p < 0.05). Conclusions: Younger patients had greater expectations of total shoulder arthroplasty, which may have implications for outcome and implant longevity.