Anatomic Shoulder Arthroplasty: The Correlation between Patient Resilience, Mental Health, and Outcome

James G Levins; Suhas P Dasari; Noah J Quinlan; Anastasia J Whitson; Frederick A Matsen 3rd; Jason E Hsu

doi:10.1016/j.jse.2024.03.008

Anatomic Shoulder Arthroplasty: The Correlation between Patient Resilience, Mental Health, and Outcome

J Shoulder Elbow Surg. 2024 Mar 26:S1058-2746(24)00220-9. doi: 10.1016/j.jse.2024.03.008. Online ahead of print.

Authors

James G Levins¹, Suhas P Dasari², Noah J Quinlan³, Anastasia J Whitson², Frederick A Matsen 3rd², Jason E Hsu⁴

Affiliations

¹ The University of Vermont Medical Center, Orthopaedics and Rehabilitation Center, 192 Tilley Drive, South Burlington, VT 05403-4440, USA.
² Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195-6500, ISA.
³ Bassett Healthcare, 1 Atwell Road, Cooperstown, NY 13326, USA.
⁴ Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195-6500, ISA. Electronic address: jehsu@uw.edu.

PMID: 38548096
DOI: 10.1016/j.jse.2024.03.008

Abstract

Background: Recovery from anatomic shoulder arthroplasty may be enhanced in patients with good mental health and the resilience to participate in the prescribed postoperative rehabilitation program. To test this concept, we utilized validated and reliable scales in determining whether resilience and mental health are associated with the outcome of anatomic arthroplasty.

Methods: 399 patients (195 ream and run (RnR) and 204 anatomic total shoulder (aTSA)) were surveyed at a mean follow-up of 6.3 ± 3.3 years. Preoperative variables included age, sex, body mass index (BMI), history of prior shoulder surgery, diabetes, visual analog scale for pain (VAS), Simple Shoulder Test (SST) scores, and Veteran's RAND-12 Mental Component Score (VR-12 MCS). Outcomes collected included the SST, American Shoulder and Elbow Surgeons Score (ASES), revision rate, and patient satisfaction. Resilience was documented using the Connor Davidson Resilience Scale-10 (CD RISC-10) at latest follow-up. Univariable and multivariable regression analyses were used to identify factors significantly associated with follow-up postoperative SST, ASES and satisfaction.

Results: In the univariable analysis, CD RISC-10 was positively correlated with postoperative SST, ASES and satisfaction after both RnR and aTSA. Mean CD RISC-10 scores were higher in the RnR cohort (34.3 ± 4.8 vs. 32.5 ± 6.2 for aTSA, p<0.001). Male sex and lower preoperative VAS were correlated with higher ASES after RnR; VR-12 MCS was positively correlated with all outcomes except SST after RnR. In the multivariable linear regression analysis, CD RISC-10 was independently associated with postoperative SST, ASES and satisfaction scores in aTSA patients. In the RnR cohort, CD RISC-10 was only correlated with satisfaction. VR-12 MCS was correlated with ASES and satisfaction after RnR.

Discussion: In this study of anatomic arthroplasties, increased resilience and better mental health were correlated with better outcomes. RnR patients had higher resilience than aTSA patients. Greater resilience was associated with better outcomes after anatomic total shoulder arthroplasty. Better mental health was associated with superior outcomes after the ream and run procedure.

Keywords: Connor-Davidson RISC; anatomic shoulder arthroplasty; ream and run; resilience; shoulder replacement recovery.