Reassessing the minimum two-year follow-up standard after total shoulder arthroplasty—Is one year sufficient?

Mahendraraj, Kuhan A.; Carducci, Michael P.; Galvin, Joseph W.; Golenbock, Samuel W.; Grubhofer, Florian; Jawa, Andrew

doi:10.1177/1758573220922845

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…However, Mahendraraj et al 8 report in their retrospective review of 250 shoulder arthroplasty patients in a single-surgeon arthroplasty registry that there were no additional complications or evidence of implant failure identified between years one and two postoperatively. In addition, they state that the American Shoulder and Elbow Score (ASES) and Visual Analogue Scale (VAS) PROMs did not increase.…”

Section: Resultsmentioning

confidence: 99%

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty

et al. 2023

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Aims Long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty remains contentious, with a wide spectrum of non-evidence-based mechanisms used. This scoping review aims to outline related evidence, thereby informing research requirements. Methods Studies relevant to shoulder and elbow arthroplasty follow-up, surveillance and time-related failure were included. The review included randomised controlled trials, systematic reviews and economic studies indexed in MEDLINE, Embase, Cochrane CDSR and Cochrane CENTRAL since 1 January 2012. In addition, all registry studies, follow-up studies, cohort studies and case reports indexed in MEDLINE since 1 January 2020 were included. The screening was undertaken by two reviewers. Key characteristics of each study were described, alongside a narrative review. Results Twenty-one articles were included. We were unable to identify evidence that long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty identifies failure or leads to a revision that is of reduced patient morbidity and cost. In addition, no evidence was apparent to inform whether patients will self-present with a failing implant. Several surveillance mechanisms were identified. Conclusion This scoping review highlights the paucity of evidence related to long-term follow-up and monitoring of shoulder and elbow arthroplasty, and the need for high-quality data to inform the development of evidence-based care pathways.

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Section: Resultsmentioning

confidence: 99%

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty

et al. 2023

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“…The two-year follow-up requirement is most likely based from studies on hip and knee arthroplasty, which indicate patients continue to recover two years after surgery [ 52 ], rather than research on shoulder arthroplasty recovery [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…An appropriate alternative could be to use a lower number of surgeries, such as 150 surgeries at two-year follow-up for clinical outcomes, in addition to PROMS data for 100 patients at one-year follow-up. A study demonstrated that shoulder arthroplasty investigations may not require the minimum two-year clinical follow-up, as PROs and range of motion scores plateaued at one year postoperatively without further complications [ 53 ]. For benchmarking purposes, further research is required to determine the appropriate number of surgeries for safety and clinical outcomes for the various indications for shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Innovative technologies for reverse total shoulder arthroplasty in Australia: Market access challenges and implications for patients, decision-makers, and manufacturers

Gumbie

Costa

Erb

et al. 2022

Journal of Market Access & Health Policy

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Purpose The success of reverse total shoulder arthroplasty (RTSA) has expanded its use for a broader range of shoulder indications worldwide. Evidence regarding the relative efficacy and long-term safety of medical technologies used in RTSA is subjected to rigorous assessment. Nonetheless, substantial challenges impede market access for innovative shoulder implant technologies for RTSA in Australia, resulting in delayed patient access. Approach This paper addresses the key challenges associated with generating evidence for the health technology assessments of innovative medical technologies for RTSA that are required for access to the Australian market. The transition to value-based care requires establishing a benchmarking reference that incorporates patient-reported outcome measures (PROMs) and combines revision outcomes with additional clinical outcomes to increase patient cohort sizes. Establishing the benchmark would require agreement on the outcome measures to be collected for each indication, and investment in reporting patient-reported outcomes for RTSA to the national orthopaedic registry. Implications for practice The need for increased flexibility in developing evidence for health technology assessment of RTSA medical technologies is required. Optimised approaches for benchmarking RTSA require extensive stakeholder discussions, including the agreement on evidence requirements and follow-up periods, selection of clinical outcomes, as well as pre-operative and post-operative PROMs as a value assessment.

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“…Additionally, many research publications require a minimum of 1 or 2 years of postoperative follow-up. 1,8,25,32 Although this standard allows for adequate understanding of recovery, results may be biased because healthy patients are less likely to continue medical assessment after substantial improvement. 19 Remote collection of PROs could support this or even longer follow-up.…”

Section: Discussionmentioning

confidence: 99%

Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery

Hunter,

Ramirez,

Thirukumaran

et al. 2024

Foot Ankle Int.

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Background: National campaigns in the United States, such as Choosing Wisely, emphasize that decreasing low-value office visits maximizes health care value. Although patient-reported outcomes (PROs) are frequently used to quantify postoperative outcomes, they have not been assessed as a tool to help guide clinicians consider alternatives or discontinue in-person follow-up visits. The purpose of this study is to assess the frequency and cost of in-person follow-up visits after patients report substantial improvement defined as 2 consecutive improvements above preoperative Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores. Methods: Retrospective PROMIS PI data were obtained between 2015 and 2020 for common elective foot (n = 759) and ankle (n = 578) surgical procedures. Patients were divided into quartiles according to their preoperative PI score. Multivariable Cox proportional hazards models were used to investigate time to substantial improvement. Substantial improvement was defined as having 2 consecutive postoperative minimal clinically important differences (MCIDs) above preoperative PROMIS PI scores. MCID was measured using the distribution-based method. Multivariable negative binomial models were used to determine the number of visits and direct associated costs after substantial improvement. The cost to payors was estimated using reimbursement rates. Results: Within 3 months, 12% to 46% of foot and 16% to 61% of ankle patients achieved substantial improvement. Results vary by preoperative pain quartile, with patients who report higher preoperative pain scores achieving earlier improvement. After achieving substantial improvement, foot and ankle patients averaged 3.60 and 4.01 follow-up visits during the remaining 9 months of the year. Visit costs averaged $266 and $322 per foot and ankle patient respectively. Conclusion: Postoperative follow-up visits are time-consuming and costly. Physicians might consider objective measures, such as PROMIS PI, to determine the need, timing, and alternatives for in-person follow-up visits for elective foot and ankle surgeries after patients demonstrate reliable clinical improvement. Level of Evidence: Level III, retrospective cohort study at a single institution.

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Reassessing the minimum two-year follow-up standard after total shoulder arthroplasty—Is one year sufficient?

Cited by 11 publications

References 26 publications

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty

Innovative technologies for reverse total shoulder arthroplasty in Australia: Market access challenges and implications for patients, decision-makers, and manufacturers

Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery

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