Tuesday, January 24, 2012

complications and survivorship in shoulder arthroplasty

The JSES recently published an article on factors predicting complications after primary hemi and total shoulder arthroplasty. Their study was based on data for all hospital discharges within the state of California in the years 1995 through 2005 were obtained from the California Office of Statewide Health Planning and Development (OSHPD), a mandatory database compiled annually by the state, and all nonfederal acute care hospitals within California containing discharge abstracts for every inpatient admission, regardless of insurance type. Auditing rules are in place to identify potentially erroneous batches of records, and a sample of the records is also audited for accuracy.

They found 15,288 patients having shoulder arthroplasty. There was no significant difference between patients undergoing total shoulder arthroplasty and hemiarthroplasty with respect to the aggregate risk of 90-day complications or the risk of implant failure within the study period. Patients having arthroplasty for fracture were shown to have a higher risk of short-term complications (odds ratio, 3.2; P < .001). Implant failure rates were lower in patients with fracture, rheumatoid arthritis, increased comorbidity, and advanced age. The overall mortality rate was 1.3%, and the pulmonary embolism rate was 0.6%.

The authors note that a variety of different complications can be encountered with shoulder arthroplasty. The most common include prosthetic loosening, glenohumeral subluxation or dislocation, periprosthetic fractures, infection, and neurovascular injury. They summarize the literature as showing an overall 14.7% complication rate, with component loosening (6.3%), particularly of the glenoid (5.3%), to be the most common.

Their finding that longer-term, implant survival is largely driven by factors associated with increased activity, such as age, suggests that there is a need for arthroplasty methods that are better suited for individuals wishing to remain active for long periods of time after surgery.  This is the motivation for our pursuit of the ream and run procedure.


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