Optimizing follow-up after anatomic total shoulder arthroplasty

Abstract

With increases in both total shoulder arthroplasty (TSA) volumes and patient life expectancies, the number of patients requiring follow-up after shoulder arthroplasty continues to grow exponentially. The purpose of this study is to establish a data-based follow-up schedule minimizing unnecessary patient and health care system costs without sacrificing patient care. Between January 1975 and January 2013, 2786 consecutive anatomic TSAs were performed at our institution. All shoulders undergoing reoperation/revision were reviewed to identify the common modes of failure and times to failure. A total of 208 shoulders (7.5%) required reoperation. Early failure mechanisms included instability, rotator cuff tears, and infection, with 63% of these reoperations occurring within 2 years. Later failures included mechanical failures (including component loosening) and periprosthetic fractures, with no identifiable peak occurrence. After 2 years, TSA failed at an average rate 1.1% per year. TSA failure after 2 years is uncommon and triggers surgical intervention in approximately 1% of patients per year. Routine in-person surveillance of all patients on a scheduled basis may not be necessary and would increase patient and other health care costs. We recommend in-person visits to assess healing, direct rehabilitation, and manage soft tissue or infectious issues until 2 years, with planned, periodic patient contact by mail and radiographic evaluation of patients with poor or worsening outcomes thereafter, unless patient concerns arise or a newer implant design warrants closer clinical assessment.