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

Abstract

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. We retrospectively reviewed patients who underwent anatomic or reverse TSA (2016-2021). At one week, patients were classified as <i>Minor Pain</i> (Visual Analog Scale (VAS) ≤ 3) or <i>Major Pain</i> (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. 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 <i>p</i> < .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. One-week postoperative pain is associated with early recovery patterns after TSA and may inform counseling, rehabilitation, and early pain management. Level III, retrospective cohort study.