Friday, August 21, 2015

Shoulder arthroplasty - survivorship - is this the right methodology?

Improved survival for anatomic total shoulder prostheses.

These authors studied 4,173 patients with shoulder replacements reported to the Norwegian Arthroplasty Register (2,447 hemiprostheses, 444 anatomic total prostheses, 454 resurfacing prostheses, and 828 reversed total prostheses) performed for osteoarthrtis, rheumatoid arthritis, acute fracture, and fracture sequelae.

Our summary of their data is shown below as the 5 and 10 year prosthesis revision rates.

They also found that patients over 70 years of age and female patients had lower prosthesis revision rates. The brand of prosthesis and type of fixation also had effects on revision rates. 

The reasons for revision are shown here:

Comment: These data cry out for a multivariate analysis. It is apparent that the type of prosthesis selected by the surgeons were not independent of other factors, such as diagnosis. Without this we cannot know which of the following factors were most important in the revision rate: type of procedure, diagnosis, age, sex, cementation, prosthesis brand or date of surgery. 

Also, as we've pointed out before, prosthesis revision is a peculiar type of endpoint - it depends on the patient's willingness to subject to another surgery when the first one failed. Some patients prefer to accept a poor functional outcome rather than rolling the dice again. This study did not include functional outcomes.


Check out the new Shoulder Arthritis Book - click here.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'