Characterizing the effect of diagnosis on presenting deficits and outcomes after total shoulder arthroplasty I. M. Parsons IV, MD, a Barry Campbell, b Robert M. Titelman, MD, b Kevin L. Smith, MD, b and Frederick A. Matsen III, MD, b Somersworth, NH, and Seattle, WA This study compared self-assessed deficits in comfort, function, and health status before and after total shoul- der arthroplasty for 4 different diagnoses: degenera- tive joint disease (DJD), secondary DJD (2°DJD), rheu- matoid arthritis (RA), and capsulorrhaphy arthropathy (CA). Deficits were assessed by the Simple Shoulder Test and Short Form 36 (SF-36) questionnaires. There was a significant difference among diagnoses for pre- operative and postoperative functional deficits. The profiles of improvement within the categories of com- fort, motion, strength, and function were different for each diagnosis. Patients with DJD and CA were most improved in the category of motion, whereas those with 2°DJD and RA were most improved in the cate- gory of comfort. There was also a statistically signifi- cant difference in 5 of the 8 domains of the preopera- tive SF-36 among diagnoses. Factors associated with each diagnosis play a significant role in determining the magnitude of preoperative deficits and postopera- tive improvement in shoulder function. (J Shoulder El- bow Surg 2005;14:575-584.) T he most common diagnoses for which total shoulder arthroplasty (TSA) is performed include primary de- generative joint disease (DJD) (osteoarthritis), second- ary DJD (2°DJD), capsulorrhaphy arthropathy (CA), and rheumatoid arthritis (RA). Each of these glenohu- meral joint diseases implicates specific factors that may have substantial impact on the effectiveness of TSA. CA is defined as arthritis resulting from previous surgical procedures for glenohumeral instability. Sec- ondary DJD is defined as arthropathy that results from sequelae of trauma or previous surgery (other than capsulorrhaphy) or from congenital problems such as glenoid dysplasia. In addition to the typical findings encountered in primary DJD, patients with 2°DJD may have altered anatomy from fracture malunion or prior surgery. Those with CA are typically younger, higher physically demanding patients with marked internal rotation contracture, scar tissue from prior operative stabilization, and posterior glenoid erosion. Patients with RA may be of low physical demand but often have an impaired healing response, adjacent joint involvement, a higher frequency of rotator cuff tears, osteopenic bone, and medial erosion of the glenoid. Although the principles and goals of TSA may be similar with each of these diagnoses, the complexity of surgery may vary considerably among them. In addition, the effectiveness of TSA in restoring comfort, motion, strength, and function may differ based on how each of these diseases impacts specific aspects of shoulder function. When counseling patients about surgery, generalizations about the outcomes of TSA that are mostly derived from series on the treatment of osteoarthritis may not be applicable in predicting effectiveness for other types of glenohumeral arthritis. Because patients’ definition of a successful result de- pends on the potential of TSA to restore the deficits they experience before surgery, understanding the impact of the specific diagnosis is important for sur- geons to recognize as they manage patients’ expec- tations for this procedure. Although previous series have reported outcomes of TSA for specific diagnoses, there is limited infor- mation that directly compares different diagnoses in terms of the extent of shoulder disability and the extent to which TSA improves shoulder comfort and function. The purpose of this study was to characterize self- assessed deficits in shoulder function and general health perception, both at presentation and at most recent postsurgical follow-up for DJD (osteoarthritis), 2°DJD, CA, and RA. The improvement in the outcome categories of comfort, motion, strength, and ability was compared among diagnoses. We hypothesized that the profile of preoperative deficits and the post- From the Seacoast Orthopaedics and Sports Medicine, Marsh- brook Professional Center, Somersworth, and Department of Orthopaedics and Sports Medicine, University of Washington, Seattle. This work was supported by the Douglas T. Harryman II/DePuy Endowed Chair for Shoulder Research at the University of Wash- ington. Reprint requests: Frederick A. Matsen III, MD, Department of Or- thopaedics and Sports Medicine, University of Washington Med- ical Center, 1959 NE Pacific St, Box 356500, Seattle, WA 98195 (E-mail: matsen@u.washington.edu). Copyright © 2005 by Journal of Shoulder and Elbow Surgery Board of Trustees. 1058-2746/2005/$30.00 doi:10.1016/j.jse.2005.02.021 575