Optimizing follow-up after anatomic total shoulder arthroplasty

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.