Sunday, June 13, 2021

Which patients do not do as well after shoulder joint replacement?

Functional Somatic Syndromes are Associated with Suboptimal Outcomes and High Cost after Shoulder Arthroplasty

The term "functional somatic syndrome" refers to chronic physical symptoms with no identifiable organic cause.  4 well-recognized functional somatic syndromes are fibromyalgia, irritable bowel syndrome, chronic headaches, and chronic low back pain.

These authors identified 480 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015-2018 with minimum 2- year follow-up. 

Nearly 1 in 5 patients (17%) reported at least one functional somatic syndrome. Those patients were significantly more likely to be women, chronic opioid users, report more allergies.have a diagnosis of anxiety, and shoulder pathology other than degenerative joint disease.

They found that that the presence of at least one functional  somatic syndrome was independently and signficantly predictive of lower 2-year ASES (-9.75 points) and  SANE (-7.63 points) scores, and greater residual pain (+1.13 points; all P ≤ 0.001). 

Each additional functional disorder was linked to a stepwise decrease in ASES and SANE scores, and an increase in residual pain (P < 0.001). 

These patients also incurred higher hospitalization costs, with a stepwise rise in costs with an increasing number of disorders (P < 0.001).

Patients with functional somatic  syndrome were more likely to be women, chronic opioid users, report more allergies, anxiety, and have a primary shoulder diagnosis other than degenerative joint disease. 

Comment: The value (benefit/cost) of shoulder arthroplasty is obviously lower in patients with functional somatic disorders.

As pointed out in a prior post (link), it may be that the opportunities for improving the outcomes of shoulder arthroplasty lie not in technological advances, but rather in patient selection with identification of risk factors for suboptimal results. 

Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The total shoulder arthroplasty (see this link).
The ream and run technique is shown in this link.
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).