| Sumario: | Obesity is a well-established risk factor for complications after total shoulder arthroplasty (TSA), and morbidly obese patients may be denied surgery due to concerns about poor outcomes. In the current health care climate, patient-reported outcome measures (PROMs) are increasingly used to define success after elective orthopedic procedures. Most studies on TSA in obese patients focus on objective metrics such as complication rates, range of motion, and radiographic parameters, while data on the subjective patient experience remain limited. The purpose of this study is to examine the effects of increasing obesity and body mass index (BMI) on PROMs and satisfaction in obese patients undergoing primary TSA. There were 2,525 patients with a BMI >30 kg/m2 who underwent primary anatomic or reverse TSA that were identified in a prospective international shoulder registry and stratified according to the World Health Organization classification for obesity. Patient demographics, preoperative and minimum 2-year postoperative PROM, patient satisfaction scores, and complications and revisions were compared between patients with Class I (BMI 30-34.99 kg/m2), Class II (BMI 35-39.99), and Class III (BMI >40 kg/m2) obesity. Class II and III patients were younger, more likely to be female, and more likely to have hypertension or diabetes than Class I patients. Preoperatively, Class III patients reported higher visual analog scale pain and lower Constant and American Shoulder and Elbow Surgeons scores than Class I or II patients, and lower Shoulder Arthroplasty Smart scores than Class I patients. TSA led to significant improvement in all PROM across all Classes. At a mean follow-up of 53 months, there were no significant between-group differences in patient satisfaction rates or PROM except for a lower Constant score in Class III patients compared to Class I patients; however, this difference did not exceed the minimum clinically important difference. In obese patients undergoing primary TSA, the severity of obesity does not have a clinically significant impact on postoperative PROM or patient satisfaction, arguing against the use of BMI cutoffs in TSA. With appropriate medical optimization, morbidly obese patients can achieve functional improvement and satisfaction levels comparable to those of their less obese counterparts.
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