Saturday, January 28, 2017

The Australian Open - total shoulder arthroplasty outcomes

With today's victory of Serena over sister Venus and tomorrow's epic match between Federer and Nadal, now seems a fitting time to salute another Australian Open:

an invaluable nationwide report of 15 year outcome data on all 32,406 primary and revision shoulder procedures undertaken up to the end of 2015.

The full report can be found in this link, here we present a few snap shots of this invaluable resource. Hats of to the Aussies (see this link).

The number of shoulder joint replacements is rising rapidly; but the revision burden is 11% and not improving. Notably the number of shoulder procedures has increased 7.3% over prior years in contrast to hip procedures that increased by 2.6% and knee procedures that increased by 5.9%.

While the proportion of revision hip procedures  declined from 12.9% of all hip procedures in 2003 to 9.6% in 2015 and revision knee procedures declined from a peak of 8.8% in 2004 to 7.4% in 2015, the percentage of revision shoulder replacements has remained at 10.8% since 2012.

*Reverses were being used with increasing frequency:

*For both conventional total and reverse shoulder arthroplasties, the revision rate was 1% per year.

*The revision rate for total shoulders performed for osteoarthritis was 11% at 9 years. The rate was higher when total shoulders were performed for fracture or osteonecrosis.

*Instability/dislocation accounted for 25% of all revisions, followed by rotator cuff insufficiency (21%) and loosening/lysis (17%). In the first two years instability and dislocation were the leading indications for revision. The rate of revision for loosening and lysis continued to rise with time and became the leading indication for revision at 7 years.
* Cementless glenoid fixation has a high rate of revision.

*All polyethylene glenoid prostheses have a lower rate of revision compared to metal backed components
*Different prosthetic stem/prosthetic head combinations had different revision rates.

Comment: These data provide standards against which current and newer arthroplasty systems can be judged. The great value of these registry data is that they represent an overall national experience, rather than the results of case series presented by surgeons who may or may not have a vested interest in the outcome.


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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'