Friday, November 18, 2016

Shoulder arthroplasty registries - why are the US, France, Germany, Switzerland and others not on the list?

A review of national shoulder and elbow joint replacement registries.

Between 1994 and 2004, 6 shoulder registries; by the end of 2009, the shoulder registries included between 2498 and 7113 replacements. The registries were initiated by orthopedic societies and funded by the government or by levies on implant manufacturers. In some countries, data reporting and patient consent are required. Completeness is assessed by comparing data with the national health authority. All registries use implant survival as the primary outcome. Some registries use patient-reported outcomes as a secondary outcome.

Data from national registries can cause us to re-think our approach.  For example, many surgeons are convinced that total shoulder is superior to hemiarthroplasty, but the Finnish data on revision rates (see below) deserve consideration.

A recent article goes a step further, asking: Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic Arthroplasty Register Association.

Emerging data from this collaboration enable comparison of survival rates among implants

Comment: Notably NOT on the list of countries with national registries are those performing the largest number of shoulder joint replacements: the United States, France, Germany and Switzerland.  Imagine how much faster we'd learn about what was and what was not working if we followed the example of our Scandinavian and South Pacific colleagues. It is also of interest that the great preponderance of shoulder arthroplasty implants are made in the countries NOT participating in national registries. One would think that the wealth created by implant sales would easily support registries in these countries

For example, the US market for extremity implants in 2015 was $934 million compared to $890 million in 2014. Shoulder implants account for 62% of the extremity market (link). If a fraction of this was used to support a registry......


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