Research Summary

Early Postoperative Pain Following Total Shoulder Arthroplasty vs Rotator Cuff Repair

Miranda Manier, BA

Key Highlights

  • Postoperative pain levels were comparable between short-stay total shoulder arthroplasty (TSA) and arthroscopic rotator cuff repair (RCR).
  • Narcotic usage was higher in the RCR group at 1 week after surgery.
  • Peak pain for both procedures occurred on postoperative day 2.
  • Despite the more invasive nature of TSA, early postoperative pain was not greater than RCR.

In a prospective study comparing postoperative pain outcomes between total shoulder arthroplasty (TSA) and arthroscopic rotator cuff repair (RCR), researchers found no significant differences in daily pain levels over a 14-day period. Both groups experienced peak pain on postoperative day 2, and although narcotic consumption was slightly higher in the RCR group during the second postoperative week, overall usage was low in both cohorts.

TSA is often perceived as more invasive and therefore more painful postoperatively compared with RCR, which can be a barrier for patients considering shoulder arthroplasty. Given that postoperative pain is a major consideration for surgical counseling and recovery planning, this study sought to clarify whether this assumption holds true when both procedures are managed with a standardized multimodal pain regimen.

The study prospectively enrolled 102 patients undergoing either short-stay TSA (n = 52) or RCR (n = 50) at a single hospital. All patients received a multimodal analgesic regimen, including an interscalene block with liposomal bupivacaine and one of two oral pain medication protocols. Patients documented their daily pain intensity using a visual analog scale (VAS) and tracked their opioid consumption in pain diaries for 14 days following surgery. Preoperative assessments included demographic data, baseline VAS scores, and pain sensitivity questionnaires. Patients younger than 40 years, those undergoing revision surgeries or TSA for fractures, and those with chronic opioid use or protocol nonadherence were excluded.

RCR patients were younger on average (60.6 vs 68.9 years, P < .01), but other baseline characteristics, including preoperative pain and pain sensitivity, were similar between groups. Peak VAS pain scores occurred on postoperative day 2 for both groups, with RCR patients reporting a mean score of 4.4 ± 3.1 and TSA patients 5.1 ± 2.7 (P = .214). No statistically significant differences in daily VAS scores were observed over the full 14-day postoperative period. There were also no pain score differences between anatomic and reverse TSA subgroups. RCR patients reported higher opioid use on postoperative days 7 and 8 (0.5 tablets vs 0.2 tablets; P = .039 and P = .015, respectively).

“Our study demonstrated that postoperative pain levels do not significantly differ between RCR and short-stay TSA, with greater narcotic usage observed for RCR at 1 week after surgery,” the authors concluded. “These findings support the notion that despite the increased invasiveness of TSA, early postoperative pain is comparable with early pain after RCR.”

Reference:
Lopez R, Schiffman C, Singh J, et al. Early postoperative pain is similar after arthroscopic rotator cuff repair vs. short-stay shoulder arthroplasty: a prospective study. J Shoulder Elbow Surg. 2025;34(5):1199-1207. doi:10.1016/j.jse.2024.08.031