Tuesday, June 16, 2015

Shoulder joint replacement arthroplasty - risk factors for revision surgery from a registry

Risk factors for revision after shoulder arthroplasty: 1,825 shoulder arthroplasties from the Norwegian Arthroplasty Register.

These authors describe the results of shoulder replacement in the Norwegian population (of 4.7 million) over a 12-year period. They found that 1,531 hemiarthroplasties, 69 total shoulder replacements (Neer type TSR), and 225 reversed total shoulder replacement (reversed TSR) operations were reported to the Norwegian Arthroplasty Register between 1994 and 2005.

The 5- and 10-year failure rates for hemiarthroplasties were 6% and 8%. The risk of revision for patients who were 70 years or older was half that of those who were younger. The main reasons for revision of hemiarthroplasties were pain and instability. The risk of revision was highest for patients with sequelae after fracture compared to those with acute fractures.

The 5- and 10-year failure rates for reversed total shoulder replacements they were 10%  and 22%.
The risk of revision was less for women than for men.  The main cause of revision was aseptic loosening of the glenoid component.

Comment: First, thanks to our colleague Mac McElvany for reminding us of this important article.
Secondly, this report points out the value of registry data that include all procedures done within a defined patient population. Third, it points out the need for long-term followup of shoulder arthroplasties - while it may be tempting to dismiss these high revision rates the fact is that we do not have eight to ten year followup on the procedures currently in use. Will this type of registry data be available for what we do now?


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