Denver Shoulder - Shoulder Replacement Outcomes

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Shoulder Replacement Outcomes

Our specialists are devoted to understanding the functional and clinical outcomes of shoulder replacement over time.

Since June of 2003, all patients who undergo a shoulder replacement are enrolled in a multi-center shoulder outcomes database. Shoulder replacement types included are Total Shoulder Replacement, Reverse Total Shoulder Replacement, Hemi Replacement, and Biological Resurfacing Shoulder Replacement. Revision shoulder replacements are also included in the study.

Routine follow up after shoulder replacement surgery is important. Our standard of care is to see patients for follow-up one, two, five, seven, ten, and fifteen years after surgery. Radiographs are obtained to evaluate the replaced shoulder over time. Clinical and functional outcomes are assessed to answer the questions “How has the shoulder replacement improved the patient’s life?” and “How long are our shoulder replacements lasting?”, common questions that almost every patient asks when considering their decision to proceed with shoulder replacement.

Approach for Assessing Shoulder Outcomes

Three approaches are used to evaluate the outcome of the shoulder:

Clinical Outcomes

Prior to surgery and at each follow-up visit, range of motion is assessed and an X-ray is obtained. Because the shoulder has greater range of motion than all other joints in the body, obtaining range of motion measurements is an essential tool for the doctor to assess shoulder health and function. X-rays allow the doctor to evaluate bone wear, rotator cuff integrity, osteolysis, implant migration, and other factors that help determine the overall health of the shoulder and the need for surgery.

Functional Outcomes

A functional assessment questionnaire is completed pre-operatively and post-operatively at yearly intervals. The functional assessment questionnaire includes three common standardized assessments:

  • Constant Score - This score measures the overall value of the shoulder by combining range of motion and strength measurements with the patient’s assessment of pain and ability to perform daily activities. This score is age adjusted, as most people experience a general decline of strength and range of motion as they age. Internationally, this is the most commonly utilized shoulder score.
  • Single Assessment Numeric Evaluation (SANE) - This assessment is a single question that asks “How would you rate your shoulder today as a percentage of normal?” Patients are asked to rate their shoulder as a percentage of normal on a 100-point scale, with 100% indicating completely normal. This is a simple question to ask, but sometimes it is difficult to answer as there are multiple domains of shoulder function and satisfaction. As a result, we also ask specific questions about satisfaction regarding these specific domains.
  • American Shoulder and Elbow Surgeons (ASES) Score - This score measures pain and the ability of the shoulder to perform activities commonly encountered on a daily basis, such as reaching high on a shelf or sleeping on the shoulder. This is the most commonly utilized score in the United States.

To view our outcomes questionnaire, click here.

Safety and Survivorship

Any unfavorable or unintended signs, symptoms, conditions, or diseases as a result of the shoulder implant are recorded. Recording the occurrence of these events allows us to track the overall safety and survivorship of the shoulder components.

Our Center’s Shoulder Arthroplasty Outcomes

The following graph shows the average improvement of functional outcome scores from baseline (prior to shoulder replacement) across the span of seven years in patients who have had a shoulder replacement at our center. It includes 937 shoulder replacements performed between June 2003 and June 2013. These cases include total shoulder replacement, hemi arthroplasty, reverse shoulder replacement, and biological resurfacing replacement. Further, this includes surgeries that were a revision of a previous shoulder replacement. The average age for individuals that received a new shoulder is 66 years. 44% of the shoulder replacements were done on males and 56% were done on females.