Summary

The outcomes represent the current perioperative practice for elective shoulder replacements in Canada.

Abstract

Purpose

Elective shoulder replacement (SR) surgery has advanced over the recent decades. Advancements were not only seen for the implanted prostheses but also in the perioperative management. The aim of this study is to identify the current perioperative management for elective anatomic (aSR) and reverse shoulder replacement (rSR) in Canada.

Methods

The study surveyed in August 2022 100 shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) using an anonymous online survey to help identify current pre-, intra- and postoperative measures used in elective SR.

Results

Thirty out of 100 (30%) CSES fellowship-trained orthopaedic surgeons participated in this online survey. In addition to standard x-rays, surgeons request preoperatively most of the time a CT (76.5%) scan and less often an MRI (8.8%). Surgical planning software is used routinely in 53.3% and in 30% only for difficult glenoids. All surgeons (100%) use at least a preoperative single-shot of antibiotics and two thirds (66.7%) give antibiotics up to 24h post-operatively. Tranexamic acid (TXA) is routinely used in 56.7% of surgeries. Intraoperatively, most surgeons (93.3%) do a long head biceps tenodesis during surgery. Most surgeons prefer a subscapularis peel-off (43.3%) or a subscapularis tenotomy (40%) versus 10% doing a lesser tubercle osteotomy, and some (6.67%) vary the approach depending on the prosthesis type. However, all subscapularis tendons are being refixated in all aSR cases (100%), but not in 16.7% of rSR surgeries. Postoperatively, all surgeons use a sling independent of anatomic or reverse SR, but the duration varies from 1 – 6 weeks. Postoperative discharge procedures vary among surgeons, approximately half the surgeons (46.7%) discharge the patient on the same day of surgery and the other half (53.3%) discharges the patient the following day.

Conclusions

The outcomes represent the current perioperative practice for elective SRs in Canada. Results demonstrate a continuous advancement in perioperative management such as the use of perioperative CT scans and pre-operative planning software for routine cases. Further progresses are seen among the decreased recommended sling time use or in the increased numbers of same day of surgeries.