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Optimizing follow-up after anatomic total shoulder arthroplasty.

Bradley Schoch1, Jean David Werthel2, Cathy D Schleck3

  • 1Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.

Journal of Shoulder and Elbow Surgery
|January 23, 2017
PubMed
Summary

Total shoulder arthroplasty (TSA) failure after two years is uncommon, occurring at about 1% annually. A revised follow-up schedule can reduce costs without compromising patient care for TSA recipients.

Keywords:
TSAanatomic total shoulder arthroplastyfollow-uplower extremity arthroplastyshouldertotal shoulder arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Clinical Outcomes Research

Background:

  • Increasing volumes of total shoulder arthroplasty (TSA) and rising patient life expectancies necessitate optimized post-operative follow-up strategies.
  • Current follow-up protocols may lead to unnecessary costs for patients and the healthcare system.
  • Developing a data-driven follow-up schedule is crucial for efficient patient management.

Purpose of the Study:

  • To establish a cost-effective, evidence-based follow-up schedule for patients who have undergone total shoulder arthroplasty (TSA).
  • To minimize healthcare expenditures and patient burden while ensuring optimal patient care and outcomes.
  • To identify optimal timing for follow-up assessments based on failure modes and rates.

Main Methods:

  • Retrospective review of 2786 consecutive anatomic total shoulder arthroplasties (TSAs) performed between January 1975 and January 2013.
  • Analysis of reoperation and revision cases to determine common failure modes and their timing.
  • Statistical evaluation of failure rates and time-to-failure data.

Main Results:

  • Reoperation was required in 7.5% (208 shoulders) of cases.
  • Early failures (within 2 years) were primarily due to instability, rotator cuff tears, and infection (63% of reoperations).
  • Late failures involved mechanical issues and periprosthetic fractures; TSA failure after 2 years occurred at an average rate of 1.1% per year.

Conclusions:

  • Total shoulder arthroplasty (TSA) failure beyond the initial two-year period is infrequent, with an approximate annual surgical intervention rate of 1%.
  • Routine, scheduled in-person follow-up for all TSA patients may not be necessary and incurs additional costs.
  • A recommended follow-up strategy includes in-person visits for the first two years, followed by periodic mail contact and radiographic evaluation for specific patient groups, adjusting for implant type and patient concerns.