Tuesday, August 4, 2015

Total shoulder arthroplasty - worker's compensation coverage may be a comorbidity

Anatomic total shoulder arthroplasty for patients receiving workers' compensation.

These authors reviewed 13 patients (all men, mean age 56 years, 12 laborers) insured by workers' compensation having total shoulder arthroplasty (WC TSA) along with 63 patients (36 men, 27 women, mean age 63 years) not insured by worker's compensation (NWC TSA).

At a minimum of two years the American Shoulder and Elbow Surgeons scores at final follow-up were significantly lower in the WC cohort (73.6) compared with the control group (86.6; P = .01). 

Only 4 of the 13 WC patients returned to work, only one to his original job.
Comment: While the authors' refer to the NWC TSA patients as a 'control' group, it is easy to see that the two populations differ in important ways other than their insurance (age, sex, occupation). Thus we cannot say how much of the difference is due to the insurance and how much to other factors - for example it is well known that younger patients do less well after total shoulder arthroplasty. In addition, the 13 WC patients had a total of 20 surgeries prior to their total shoulders - another risk factor for poorer outcome.

Our approach to patients on workers' compensation is to clarify with all parties that the goal of surgery is an improved quality of life for the patient, not a return to their prior job. With this in mind, we encourage vocational rehabilitation before deciding on surgery, in that a job change may lessen the patient's symptoms from their arthritis and delay the need for surgery.


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