Postoperative outcome assessment

Postoperative reviews are determined by the likely rate and completeness of healing of the periprosthetic fracture. Therefore, the patient should be checked when the natural history of healing is anticipated to show union, and then consolidation of the fracture. These time points are generally at six weeks, three months, and six months following surgery. Imaging is obtained at these time points to monitor fracture healing.

Long-term outcome reviews are relevant to understand the value of the intervention for the patient. Ideally, the patient should be checked at one year, two years, five years, and ten years postoperatively.

Both subjective (patient) and objective (clinician) observations are relevant to understanding the value of the intervention.

There are many ways to assess the outcome from a patient’s perspective. Subjective scores include the following:

• Patient-reported outcome measures (PROMs)
• Subjective shoulder value (SSV)
• Shoulder pain and disability index (SPADI)
• Visual analog scale for pain (VAS)
• A general health questionnaire such as SF-36 or EQ5D-5F measures

There are many such assessment tools. Individual institutions will need to use the most appropriate for their cases.

There are many ways to assess the outcome from a clinician's perspective. Objective evaluation includes the following:

• Range of motion (ROM)
• Strength testing

These measures are included in many outcome scores. Commonly used outcome scores include:

• Constant–Murley score
• American Shoulder and Elbow Surgeons (ASES) score

There are many such assessment tools. Individual institutions will need to use the most appropriate for their cases.

Routine radiographs are obtained at postoperative follow-up visits. X-rays are obtained in three views (true AP, axillary view, Y view).

A CT scan of the arm may be helpful if there is any doubt about the completeness of healing or the security of implantation of the prosthesis. This is relevant if there is any doubt about the safety of progression of rehabilitation.

Adverse events are related to:

• The general health of the patient
• Function of the prosthesis
• Healing of the periprosthetic fracture

Most adverse events relating to the prosthesis occur within the first three months. These include:

• Infection
• Instability including dislocation
• Failure of prosthetic implantation

Adverse events relating to the fracture include:

• Nonunion
• Infection
• Fixation implant failure or loosening

Late adverse events include

• Infection
• Aseptic prosthetic loosening
• Prosthetic wear