Higher preoperative expectations independently predict greater improvements in physical function, pain interference, and social satisfaction at 2 years following total shoulder arthroplasty.
Are higher preoperative expectations associated with improved 2-year patient-reported outcomes in patients undergoing total shoulder arthroplasty?
Higher preoperative expectations are independent predictors of improved physical function, pain, and social satisfaction 2 years after total shoulder arthroplasty.
Preoperative expectations are increasingly recognized as a factor influencing postoperative outcomes in orthopedic surgery. The relationship of preoperative expectations and Patient-Reported Outcomes Measurement Information System (PROMIS) patient-reported outcomes (PROs) in total shoulder arthroplasty (TSA) remains understudied. This study aimed to evaluate whether higher preoperative expectations are associated with improved 2-year patient-reported outcomes (PROs). Patients undergoing anatomic or reverse TSA between June 2015 and April 2022 were retrospectively identified from a prospectively enrolled orthopedic registry. Preoperative expectations were assessed using the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). PROs were collected at baseline and 2-years postoperatively, including six domains of PROMIS, American Shoulder and Elbow Surgeons score (ASES), numeric pain scales (NPS), Tegner Activity Scale (TAS), and Marx Activity Rating Scale Upper Extremity (MARS UE). Non-parametric tests and multivariate linear regressions were performed to evaluate the relationship between preoperative expectations and 2-year PROs. Of 174 eligible patients, 140 (80.5%) completed 2-year follow-up. Patients with prior ipsilateral shoulder surgery had significantly lower preoperative expectations (p=.005). Higher expectations were associated with better 2-year PROs across functional, pain, and activity metrics, in addition to greater met expectations. Regression analysis demonstrated that preoperative expectations independently predicted better 2-year and greater improvement in PROMIS Physical Function, PROMIS Pain Interference, and PROMIS Social Satisfaction. Higher preoperative expectations were significantly associated with better 2-year PROs following TSA and were independent predictors of improvements in physical function, pain, social satisfaction, and expectation fulfillment. These findings suggest that patients with higher expectations may have superior clinical outcomes after TSA.
Yang et al. (2026) studied this question. Higher preoperative expectations independently predict greater improvements in physical function, pain interference, and social satisfaction at 2 years following total shoulder arthroplasty.