Patients with comorbidities gain more relief from rotator cuff repair

Though they have worse postop health, patients with comorbidities report better improvements in pain, function and quality of life.

Compared to healthier patients, those with medical comorbidities report greater improvements in overall shoulder pain, function and quality of life following rotator cuff repair, according to a study in the Journal of Bone and Joint Surgery.

Previously, Andrew Green, MD, of Brown Medical School in Providence, R.I., and colleagues found that comorbidities negatively affected preoperative function and general health status (P<.05). But their new study suggests that for these patients, starting out with worse functional scores allows more room for improvement postoperatively.

“People with other medical issues should not be dissuaded from this kind of shoulder surgery,” Green said in a press release. “In fact, rotator cuff repair restores shoulder function so well to a point where the patients’ other medical conditions no longer influence their perceived postsurgical shoulder function.”

Patient stats

The prospective study included 206 shoulders in 199 consecutive patients with chronic full-thickness rotator cuff tears, of whom 125 patients (125 shoulders) completed the one-year follow-up evaluation. These patients had a mean age of 56 years.

Patients had a mean 1.91 ± 1.51 medical comorbidities, ranging from 0 to 6. Rotator cuff tears averaged 2.2 cm, ranging from 1 cm to 4 cm, and symptoms persisted for a mean 16.04 ± 25.91 months prior to evaluation. Seventy-nine shoulders (63%) also had a history of injury.

Surgeons performed an open repair in 26 shoulders (21%), a mini-open repair in 62 shoulders (50%) and a complete arthroscopic repair in 37 (30%). At one-year follow-up, the researchers found significant improvements in six of the eight SF-36 subsections, including physical function (P=.02), role physical (P<.001), bodily pain (P<.001), vitality (P=.04), social function (P=.02) and role emotional (P=.03) , according to the study.

The researchers also found significant improvements (P<.001) in all functional outcome parameters as follows:

Visual Analog Scale (VAS) pain: mean 4.08 point improvement;
VAS Function: mean 4.03 point improvement;
Quality of life VAS: mean 3.5 point improvement;
Disabilities of the Arm, Shoulder and Hand (DASH): mean 23.21 point improvement; and
Simple Shoulder Test (SST): 34.2% positive responses.

Relief despite comorbidity

The authors found a significant linear correlation between the number of comorbidities and postoperative improvement in VAS scores for pain (P=.009), function (P=.022) and quality of life (P=.041), as well as DASH score (P=.044) for function, according to the study.

“This study shows that even people with serious conditions like heart disease and diabetes mellitus can experience significant relief from their shoulder pain and improvement in their shoulder function,” Green said.

Significant association also existed between a higher number of comorbidities and a significantly worse postoperative score for four SF-36 subsections — role emotional (P=.045), bodily pain (P=.032), general health (P=.001) and vitality (P=.003).

Study limitations included incomplete follow-up of all patients initially included in the study, no rotator cuff healing assessments and assumed equal weighting for all comorbidities, the authors noted.

For more information:
Tashjian R, Henn F, Kang L, Green A. Effect of medical comorbidity on self-assessed pain, function and general health status after rotator cuff repair. J Bone Joint Surg Am. 2006;88:536-540.