Friday, October 26, 2012

A review of national shoulder and elbow joint replacement registries. JSES

A review of national shoulder and elbow joint replacement registries published by JSES presents an analysis of national shoulder (6) and elbow (5) joint replacement registries. The countries having established such registries include Australia, Denmark, Finland, Norway, Sweden (funded by the respective governments), New Zealand (funded by levies on implants, government agencies, and a private group) and the UK (funded by a levy on implants). No registries were identified in the US or Canada. The authors point to the importance of such registries, which characteristically use revision as the primary outcome.

As was pointed out in a recent post, the revision rates from these registries is often higher than those from published case series - possibly because they reflect data from all surgeons, rather than only from high volume centers. To this point, the recent JSES article shows the revision rates for total shoulder and hemiarthroplasty by year as in the figure below. While the authors suggest that the data shown demonstrate that the results are getting better with time, it appears that for both older and more recent total shoulder arthroplasties, there was a five percent revision rate in the first 2 years. 

These data suggest that revisions are required more commonly than might be suspected from published case series. To understand how the practice of shoulder arthroplasty can be improved, we need data such as these as well as data on the factors associated with higher risks of revision. Risk factor information does not seem to be commonly available from registry data. While the authors suggest that comparison of results with different arthroplasty designs would be an important topic for suggestion, we suggest that other factors, such as age, gender, comorbidities, BMI, diagnosis, prior surgery and surgeon experience might be of even greater interest and would at least be factors that needed to be controlled in comparisons of prostheses.


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