Sunday, August 19, 2012

Outcome of Shoulder Arthroplasty: Australian Orthopaedic Association

The Australian Orthopaedic Association has published a report on the outcomes of shoulder arthroplasty.  This report represents the results of a highly commendable effort: "data presented in this report have been submitted to the Registry by both public and private hospitals. Currently this involves 300 hospitals nationally". The report includes surgeries performed from April 2004 to December 2010.

This study deserves careful reading.

(1) The cumulative revision rate at three years was 10%  for total resurfacing (glenoid component + resurfacing humeral prosthesis (i.e. one that did not require resecting the head)), 5.4% for anatomic total shoulders and 5.2% for reverse total shoulders. It is not known if the increased revision rate for total resurfacing was due to problems with the humeral component, the glenoid component or both.

(2) The revision rate for anatomic total shoulders was similar for patients <65 years of age, those 65-72, and those over 75. The three year revision rate was slightly higher for female patients (5.8%) than for male patients (4.6%).

(3) As shown by their figure ST05, shoulders with cementless glenoid components had almost three times the revision rate at 3 years (approximately 9%) in comparison to those with cemented glenoid components (approximately 3%).

(4) The two year revision rates varied substantially for different anatomic total shoulder prostheses as shown in the figure below. It is unknown whether this variation was a reflection on the prosthesis design or on the surgeons that selected the different prostheses.

(5) The first year revision rates for reverse total shoulders were higher when the procedure was performed for fracture/dislocation (5%) than for other diagnoses (3-4%).

(6) While age did not appear to change the risk for reverse total shoulder revision, males had a higher rate at three years (6.7%) than females (4%). 

(7) Different reverse prostheses were associated with different two year revision rates: Delta CTA (5.8%), SMR (5.8%), Trabecular metal (4.3%), Aequalis (3.1%), Delta Xtend (2.4%).

This study is valuable because it reflects a large number of practices and because it uses a clear outcome measure: revision rate.  It would be of interest if, in future reports, the authors could publish the reasons for revision (stiffness, instability, infection, humeral component loosening, glenoid component loosening, fracture, etc). 


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