Does long-term follow-up and monitoring of primary shoulder arthroplasty identify failing implants requiring revision?

Abstract

BACKGROUND: Published scoping review has identified evidence paucity related to long-term follow-up of shoulder arthroplasty. We aim to report effectiveness of elective primary shoulder arthroplasty surveillance in identifying failing implants requiring revision. METHODS: Analysis of a prospective database recording shoulder arthroplasty and subsequent follow-up surveillance in a shoulder unit. Shoulder arthroplasty were performed by 4 fellowship-trained shoulder surgeons for accepted elective indications including the use of anatomic arthroplasty in arthritic shoulders with intact rotator cuff and a reverse prosthesis being utilized in rotator cuff deficient shoulders and rotator cuff competent arthritic shoulders when deemed preferable by the treating surgeon. All shoulder arthroplasty implants utilized had achieved a minimum 7A Orthopaedic Data Evaluation Panel (ODEP) rating. Included shoulder arthroplasty were performed 01/05/2004-31/12/2021 with minimum 1-year follow-up. Surveillance program involves specialist physiotherapist review at 1, 2, 3, 5, 8, 10, and 15-years postoperatively including clinical examination, outcome scoring and radiographs. Patient-initiated review occurred between timepoints if a patient requested assessment due to symptoms. Outcome measures include ratio of failing implants identified by surveillance and patient-initiated review, with number of surveillance reviews offered and proportion that identified a failing implant requiring revision calculated. RESULTS: 1002 elective primary shoulder arthroplasty with minimum 1-year follow-up were performed (547 reverse total shoulder arthroplasty [rTSA], 234 anatomic total shoulder arthroplasty [aTSA], 221 hemiarthroplasty [HA]). 238 patients died prior to 31/12/2022 resulting in 4019 surveillance appointments offered. 38 prostheses required revision ≥ 1-year postoperatively (6 rTSA, 9 aTSA, 23 HA) with surveillance identifying requirement in 53% (33% rTSA, 56% aTSA, 57% HA) and patient-initiated review in 47%. Mean years from implantation to revision was 5.2 (2.7 rTSA, 3.6 aTSA, 6.6 HA). Revision indications included rotator cuff failure (56% aTSR, 43% HA) and glenoid erosion (57% HA). CONCLUSION: This is the first series reporting effectiveness of shoulder arthroplasty surveillance in identifying implants requiring revision. Surveillance identified over half of implants requiring revision though only 0.5% of appointments identified revision requirement. Surveillance enrolment may influence patient-initiated review utilization therefore similar studies utilizing only patient-initiated follow-up would help inform recommendations.