High prevalence of outpatient falls following elective shoulder arthroplasty

Sridharan, Mathangi; Everhart, Joshua S.; Frantz, Travis; Samade, Richard; Neviaser, Andrew S.; Bishop, Julie Y.; Cvetanovich, Gregory L.

doi:10.1016/j.jse.2019.11.019

Cited by 14 publications

(10 citation statements)

References 26 publications

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“…Reverse total shoulder arthroplasty (RTSA) implantation rates continue to grow worldwide due to an extension of the indications as well as an aging society. 7,16,20,24,27 The original Grammont prosthesis was used for rotator cuff arthropathy associated with pseudoparalysis of elevation. 12 Since then, reliable clinical results have expanded the range of indications.…”

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confidence: 99%

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Kriechling¹,

Loucas²,

Loucas

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The use of reverse total shoulder arthroplasty (RTSA) has spread worldwide as a result of an expansion of indications and an aging society. However, the value of RTSA for very old patients is rarely analyzed. This study was conducted to investigate the outcome of primary RTSA in patients older than 80 years. Methods: We identified 171 shoulders (159 patients) treated with RTSA at an age of more than 80 years between January 2005 and March 2018. The primary outcome parameters were Subjective Shoulder Value (SSV) and the Constant-Murley score, mortality, complications, and reoperation rates. Secondary outcomes were adverse radiographic outcomes. A minimum follow-up of 1 year was accepted in 14 patients (8%) because of these patients' older age. Results: We included 171 cases (159 patients; 120 female) with a mean age of 84 AE 3 years (range 80.1-94). The main indication for RTSA was cuff tear arthropathy (43%), isolated rotator cuff tear (22%), and fracture (21%). A total of 136 patients (79%) were eligible for physical examination with a mean follow-up of 41 AE 25 months (12-121). Relative Constant-Murley scores improved significantly from 39% AE 19% to 77% AE 16% and SSV from 31% AE 18% to 74% AE 22%. The range of motion and force improved significantly as well. The surgical site complication rate was 30%, with a reoperation rate of 8% (13 patients) mainly due to fracture and glenoid loosening. The overall mortality was 16% with a mean time to death of 53 AE 31 months (95% confidence interval 15, 120), thereby no higher than the age-adjusted, expected mortality rate without this procedure. Conclusion: Despite a quite high postoperative complication rate, RTSA is a valid therapeutic option in patients older than 80 years, with an unexpectedly low medical complication rate and good to excellent improvement of shoulder function and pain.

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confidence: 99%

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Kriechling¹,

Loucas²,

Loucas

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Despite this statistically significant difference in age between the groups (P < .001), there was no association between age and either TUG score or gait speed. Similarly, Sridharan et al 37 did not find age to be a significant risk factor for outpatient falls after shoulder arthroplasty in their retrospective review of 198 patients.…”

Section: Discussionmentioning

confidence: 91%

“…Falls are relatively common after shoulder surgery, both in the inpatient setting and during the 90-day postoperative period after discharge. 27,37 As the number of outpatient TSA and RCR surgeries increase, understanding and preventing the risk of falls will become increasingly important. Our data reveal that the majority of patients undergoing TSA and RCR have a significant preoperative risk of falls.…”

Section: Discussionmentioning

confidence: 99%

“…27 Furthermore, this fall risk is not merely limited to the inpatient setting during the first few postoperative days. Sridharan et al 37 evaluated the fall risk in shoulder arthroplasty cases that were done in the outpatient setting in order to include the risk of postdischarge falls. Their study highlighted an outpatient fall rate of 10.6% (21 of 198 total cases) within 90 days after discharge.…”

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confidence: 99%

“…Further analysis from their data found that of those who sustained a fall, 23.8% of cases (5 of 21) required evaluation in an emergency department, 19.0% (4 of 21) required readmission, 19.0% (4 of 21) had an injury to an anatomic site other than the shoulder, and 4.8% (1 of 21) had an injury at the surgical site itself. 37 Gait speed and Timed Up and Go (TUG) test are reliable and validated functional measures in the aging population with established cutoff scores for increased fall risk. 2,17,31,32 Gait speed has been found to be an indicator of overall health status and predictor of mortality.…”

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confidence: 99%

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Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk

Kaiser

Shanley

Denninger

et al. 2021

Journal of Shoulder and Elbow Surgery

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Introduction: Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, and it includes advanced age, impaired upper extremity function, use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery. Previous literature looking at fall risk in elective orthopedic procedures has predominantly focused on falls occurring in the hospital setting, although falls have also been shown to occur in the outpatient setting. Gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cutoff scores indicating increased fall risk. The purpose of this study was to quantify gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA) in order to assess overall risk of fall in these populations. Methods: A total of 198 patients scheduled for TSA or RCR surgery were evaluated preoperatively from multiple outpatient physical therapy clinics within Greenville, South Carolina. The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7 m/s considered high risk for falls) were recorded for each patient. Patient-reported outcomes were also collected, including Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Single Assessment Numeric Evaluation. Results: Patients undergoing TSA (n ¼ 80; 65.4 AE 11.4 years) were older than those undergoing RCR (n ¼ 118; 59.0 AE 14.2 years). Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group (62% vs. 38%; c 2 ¼ 8.9, P ¼ .03). There were no significant differences in ambulatory status, Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, or Single Assessment Numeric Evaluation scores between groups (P ¼ .11). Discussion: Both patient groups demonstrated a high rate of fall risk in preoperative evaluation. Patients undergoing TSA more often displayed fall risk compared with patients undergoing RCR. Although patients in the TSA group were older, there was no association between age or ambulatory status and fall risk. Conclusion: Our results suggest that fall risk screening may be important for patients undergoing TSA and RCR surgeries. The higher fall risk in the TSA group may be an important consideration as this procedure shifts toward outpatient status.

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Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty

Zhao,

Ferraro,

Agarwal

et al. 2024

Osteoporos Int

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High prevalence of outpatient falls following elective shoulder arthroplasty

Cited by 14 publications

References 26 publications

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk

Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty

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