title: Comparison of satisfied and dissatisfied patients 2 to 5 years after anatomic total shoulder arthroplasty.
abstract: BACKGROUND
  With an increasingly large number of patients undergoing total shoulder arthroplasty (TSA) combined with increased requirements for public reporting of patient outcomes, there is a greater need to better understand the underlying factors related to patient satisfaction. The purpose of this study was to compare patient demographics, nonorthopedic comorbidities, patient-reported outcome scores, and range of motion of patients who reported being either satisfied or dissatisfied with their procedure at midterm follow-up.
  
  
  METHODS
  We identified 234 primary TSAs performed by a single surgeon for glenohumeral osteoarthritis with a minimum 2-year follow-up in a prospective shoulder arthroplasty registry. American Shoulder and Elbow Surgeons (ASES) score, patient satisfaction, and active forward flexion, abduction, and external rotation at 0° of flexion-abduction were assessed before and after TSA.
  
  
  RESULTS
  Of the 234 patients, 207 (88.5%) were satisfied with their procedure. Dissatisfied patients had significantly lower ASES scores both before and after surgery (P < .001) as well as a significantly lower preoperative to postoperative change in ASES score (P < .001). Similarly, dissatisfied patients demonstrated significantly lower changes in active forward flexion (P = .004), abduction (P = .02), and external rotation (P = .03). Patients with ASES score changes <12 points were 19 times more likely to be dissatisfied after TSA (95% confidence interval, 4.4-81.4; P = .0001).
  
  
  CONCLUSIONS
  Dissatisfied patients had significantly lower improvements in pain, function, and range of motion. Furthermore, a change in ASES score <12 points was associated with a 19-fold increase in the risk of being dissatisfied after TSA.
authors.affiliation: Lexington Clinic Orthopedics, Lexington, KY, USA. Electronic address: calejacobs@hotmail.com.
authors.forename: Cale A
authors.initials: CA
authors.lastname: Jacobs
authors.affiliation: Lexington Clinic Orthopedics, The Shoulder Center of Kentucky, Lexington, KY, USA.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Lexington Clinic Orthopedics, The Shoulder Center of Kentucky, Lexington, KY, USA.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Sciascia
authors.affiliation: Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
authors.forename: T Bradley
authors.initials: TB
authors.lastname: Edwards
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D017060:Patient Satisfaction; D011184:Postoperative Period; D057234:Preoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology; D016896:Treatment Outcome
keywords: Total shoulder arthroplasty; activities of daily living; osteoarthritis; outcome; pain; range of motion; satisfaction