Saturday, October 26, 2013

Revision shoulder arthroplasty in New York

Revision Total Joint Arthroplasty: The Epidemiology of 63,140 Cases in New York State.

The authors examined the New York State SPARCS inpatient database to identify revision total shoulder, knee, and hip arthroplasty procedures between 1993 and 2010. 

A total of 1,806 revision were identified in comparison to 26,080 revision total knees, and 35,254 revision total hips.  Of the 1,806 patients (mean age = 62.7 ± 13.6) who underwent revision shoulder arthroplasty, there was an increase from 45 in 1993 to 189 in 2010, a population-based rise of 288%, from 0.3/100,000 to 1.3/ 100,000. The reason for revision was coded as mechanical complication in 53.4%, arthritis in 7.8%, joint pain/stiffness in 6.6% , infection in 5.4%, periprosthetic fracture in 3.1%, and joint dislocation in 1.4%.

They observe that because of the long time that may elapse between a primary and a revision shoulder arthroplasty, it is possible that the revision rate for the later years may be underestimated.

The authors quote a prior article regarding rates of shoulder and elbow arthroplasties based on the Nationwide Inpatient Sample (1993-2007). Those authors found that procedure volumes and rates increased at annual rates of 6% to 13% from 1993 to 2007. The revision burden increased from approximately 4.5% to 7%. The hospital length of stay decreased by approximately 2 days for total and hemishoulder procedures. Charges, in 2007 Consumer Price Index-adjusted dollars, increased for all 4 procedural types at annual rates of $900 to $1700.

Taken together, these two studies demonstrate that the revision rate after total shoulder arthroplasty is substantial and that the cost of these revisions must be included in studies of the cost-effectiveness of the procedure.

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