Tuesday, December 6, 2011

Revision Rate after Total Shoulder Joint Replacement Arthroplasty.

A recent article in the British Journal of Bone and Joint Surgery presents the results of a very large case series of total shoulder joint replacement revisions at the Mayo Clinic.

During the period of study (1976 to 2008), 2588 total shoulders were performed by experienced surgeons.  The known revision rate was 6% at 5 years, 10% at 10 years, and 19% at 20 years. This is consistent with the commonly proposed 'rule of thumb' that the revision rate is approximately 1% per year after this procedure when performed in expert hands.

The authors found that the risk of revision was significantly higher for male patients and for patients with rotator cuff disease (although details on the nature of the rotator cuff disease are not provided in the article).
The authors do not indicate the reason for revision surgery: pain, stiffness, infection, humeral component loosening, glenoid component problems, etc. While it appears that during this interval a number of different prosthetic designs (peg glenoids, keeled glenoids, metal backed glenoids, for example) the relationship between prosthesis design and revision rate is not detailed in this paper.  Finally, while the authors attempted to capture all revisions, including those done elsewhere, the number of patients lost to followup could not be accurately determined.

Be sure to check out the other posts regarding failure of total shoulder arthroplasty, starting with this one.

Finally, it is important not to equate "revision" with "failure" or "unsatisfactory result" in that patients who do not have a good result from their shoulder arthroplasty may not choose to have a second revision procedure. The rate of loosening of the glenoid component commonly reported is much higher than the revision rate reported in this article. Thus, 'revision rate' may underestimate the 'failure rate'.

We suggest that assessment of the functional outcome of shoulder arthroplasty using patient self-assessment of comfort and function before and after surgery may be a more meaningful measure for evaluating success / failure of this surgery than the revision rate.

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