(1) what are the effects of these mental health conditions on the outcomes of shoulder arthroplasty?
(2) can the adverse effects of depression and/or anxiety be modified (i.e are these risk factors modifiable)?
(3) how should the presence of depression and/or anxiety affect the decision to proceed with shoulder arthroplasty, recognizing the increased risk for suboptimal results and adverse outcomes?
The authors of the Impact of Mental Health on Outcomes After Total Shoulder Arthroplasty sought to examine the correlation between the preoperative diagnoses of anxiety and depression and their association with postoperative outcomes for TSA. A secondary goal was to determine whether patients on medication for their mental health diagnosis fared better than those not receiving medication.
In the authors' practice over one-third (37%: 218 patients (114 rTSA and 95 aTSA)) had anxiety and/or depression while 378 (153 rTSA and 217 aTSA) had no such history.
For patients having reverse total shoulder arthroplasty, the preoperative patient and shoulder characteristics of those without and with depression and/or anxiety were essentially the same. However, the postoperative comfort, function, satisfaction and adverse event rate were significantly worse for those with depression and/or anxiety.
For patients having anatomic total shoulder arthroplasty, the results were similar, but somewhat less striking.
Patients on medications for treatment of depression and/or anxiety did not have better postoperative outcomes or satisfaction rates compared to those who had depression and/or anxiety but who not on medication. However, it is not known (1) whether the patients on medication had more severe depression and/or anxiety than those not on medication and (2) whether the patients on medication would have had even worse outcomes had they not been medicated.
Poorer mental health correlated with worse postoperative functional outcomes, worse patient satisfaction, and higher rates of adverse events.
Comment: The high prevalence of anxiety/depression is striking. As emphasized in this study as well as in Shoulder arthritis: the relationship of function, depression and anxiety and Total shoulder - one in seven patients have depression; what difference does that make? poor mental health is associated with poorer outcomes following shoulder arthroplasty.
The authors suggest that preoperative identification of these mental health disorders may allow for treatment and "an opportunity to intervene and mitigate any deleterious effect". However it is not clear whether medical management of anxiety/depression mitigates their adverse effects on arthroplasty outcomes. To figure this out, it would be necessary to randomize patients with anxiety/depression to treatment and non-treatment groups prior to arthroplasty.
It is also not clear how surgeons should consider the patient with suboptimal mental health. Should they counsel these patients that they are more likely to get a poor result? Or should they consider not offering surgery to these patients to avoid the ramifications of bad outcomes for the patient and for the surgeons themselves?
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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 ream and run procedure (see this link).
The total shoulder arthroplasty (see 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).
