Prognostic value of one-week postoperative pain for early recovery after total shoulder arthroplasty

Abstract

Introduction

Predicting recovery after total shoulder arthroplasty (TSA) remains challenging. While very early postoperative pain (24–48 h) has been linked to outcomes, this metric is rarely available in routine practice. The one-week visit is more universally captured, yet its prognostic value has not been systematically evaluated.

Methods

We retrospectively reviewed patients who underwent anatomic or reverse TSA (2016–2021). At one week, patients were classified as Minor Pain (Visual Analog Scale (VAS) ≤ 3) or Major Pain (VAS ≥ 7); those with intermediate scores (VAS 4–6) were excluded. Outcomes included VAS, Patient-Reported Outcomes Measurement Information System (PROMIS)–Upper Extremity (UE), PROMIS–Pain Interference (PI), PROMIS–Depression (D), and active range of motion at six weeks, three months, six months, one year, and ≥2 years. Minimal clinically important difference (MCID) thresholds identified clinically meaningful improvement.

Results

Among 217 patients (162 Minor, 55 Major Pain), higher one-week pain was associated with worse VAS, PROMIS–PI, and PROMIS–UE scores through six months (all p < .05), but differences resolved by one year. MCID analyses revealed faster early gains in Minor Pain patients, while Major Pain patients improved more gradually but continued progressing over time.

Conclusion

One-week postoperative pain is associated with early recovery patterns after TSA and may inform counseling, rehabilitation, and early pain management.

Level of evidence

Level III, retrospective cohort study.