Moderate evidence suggests that depression is associated with inferior post-operative outcomes in patients with glenohumeral joint osteoarthritis undergoing arthroplasty.


There was one high quality study (Werner et al 2017) which evaluated the outcomes of patients with glenohumeral joint osteoarthritis who underwent total shoulder arthroplasty. The authors performed a retrospective analysis of a cohort of 88 patients from their prospectively collected institutional database who had a diagnosis of depression and underwent total shoulder arthroplasty for osteoarthritis. They compared this group to an age and gender/sex-matched control group without depression in a 2:1 ratio (control group N=176). Their results showed that the while the depression group had significant improvement in their outcome scores (SF-12, ASES Score, Marx Activity Score, and custom satisfaction questionnaire) at a minimum of 2-year follow-up, the degree of improvement in ASES, SF-12 and satisfaction scores was significantly less when compared to the cohort of patients without depression. However, this difference in improvement did not achieve clinical importance. The authors concluded that patients with depression should be counseled about the impact of their diagnosis on outcomes after total shoulder arthroplasty but that patients should not be excluded from surgical treatment just because of their depression.


Strength of Evidence (quality of evidence): Moderate


Benefits & Harms:

There are no known harms associated with implementing this recommendation.


Cost Effectiveness/Resource Utilization:

Healthcare institutions and health insurance payors continue to move toward incorporating patient reported outcomes and patient satisfaction scores into compensation and reimbursement formulas. Therefore, identifying patient factors, such as depression, that has a significant impact on these outcome measures becomes important.


Future Research:

Further prospective studies on the diagnosis of depression and its effect on patients undergoing shoulder arthroplasty are needed. The study cited here examined depression as a discrete variable but was not able to distinguish between severity of depression and its effect on outcomes measures. Also, further work should evaluate whether the treatment of depression might affect the outcomes for these patients to determine if there is an ability to modify/improve outcomes if patients’ depression is treated appropriately.


The Future of OrthoGuidelines


The OrthoGuidelines Process