Friday, December 19, 2014

Shoulder joint replacement arthroplasty - revisions for failure on the rise

The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty.

These authors assessed the trends in shoulder arthroplasty using the Nationwide Inpatient Samples for 2009 through 2011.

They estimated that 52,397 primary shoulder arthroplasties (anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty) were performed in 2009 increasing to 67,184 cases in 2011.

Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases. The highest rate of reverse shoulder arthroplasty was in the 75- to 84-year-old female subgroup. 

Revision cases comprised 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were because of mechanical complications/loosening whereas 18% were because of dislocation.

Comment: One of the most important conclusions that can be derived from this study is that the number of revisions for shoulder arthroplasty is on the rise as shown in the plot of their data showing number of revision cases/year by year.

Their observation that over half of these revisions are for mechanical problems, suggests that better surgeon training may help curb the rate of rise of these complications. It also suggests that as a specialty we need to help decide how to best manage these revisions. Frequently, we are referred a failed arthroplasty by a surgeon who states that he/she is comfortable with doing a primary but not a revision.


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