A group of researchers from Boston asked the question, “Do women have better outcomes than men when it comes to total shoulder arthroplasty (TSA)?” Their research, recently published in the Journal of Shoulder and Elbow Surgery, says “no.” However, they do have different expectations of the surgery.
TSA: Gender Expectations—Not Results—Differ
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The study, conducted by researchers from The New England Baptist Hospital and Beth Israel Deaconess Hospital, involved 63 patients (36 men and 27 women) who underwent TSA and were then followed for a minimum of three years.
Andrew Jawa, M.D., an orthopedic surgeon with New England Baptist Hospital and a co-author on the study, told OTW, “Anecdotally, we observed that women seemed to have better outcomes than men. We wanted to test this hypothesis with a scientific study and to see if there was any relationship to differences in preoperative expectations.”
“Our findings indicate that men and women have different expectations for shoulder arthroplasty, but have similar outcomes. Specifically, men most valued participation in sports while women valued being able to perform daily activities and chores. Both men and women hope to sleep through the night without shoulder pain.”
Dr. Jawa told OTW, “I think the results lend themselves to trying to understand the differences in expectations for many orthopaedic procedures for various subgroups of patients. Understanding these differences may help us better counsel patients preoperatively. Specifically, there may be a difference in expectations and outcomes for reverse shoulder arthroplasty—a hypothesis we are interested in studying.
“Taking the extra time to manage patient expectations preoperatively may lead to more satisfied patients.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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