These authors assessed their thirty and ninety-day reoperation rates after shoulder arthroplasty from 2000 to 2010. The study included 2305 primary arthroplasties (502 hemiarthroplasties, 1440 anatomic total shoulder arthroplasties, and 363 reverse total shoulder arthroplasties) and 518 revision arthroplasties (twenty-one hemiarthroplasties, 356 anatomic total arthroplasties, and 141 reverse arthroplasties).
For primary arthroplasty, the 30 day revision rate was 0.6%. By 90 days the revision rate more than doubled to 1.4%.
For revision arthroplasty the 30 day revision rate was 1.5%. By 90 days the revision rate increased to 2.5%. 20% of patients undergoing reoperation required two or more additional procedures. Reoperations led to readmission in 82% of cases
So we can see that (1) revisions increase with time and (2) revision is more likely to require another revision.
The most frequent causes for reoperation after primary and revision arthroplasty were instability (n = 14 and 6) and infection (n = 13 and 3). The revision procedures were debridement (n = 5), closed reduction (n = 3), component revision (n = 2), rotator cuff repair (n = 2), and open reduction (n = 1).
Comment:
Comparing the results of this study to those shown in a recent post , it can be seen that the reasons for early revision are different from the reasons for all revisions, the latter including mechanical complication in 53.4%, joint pain/stiffness in 6.6% , infection in 5.4%, periprosthetic fracture in 3.1%, and joint dislocation in 1.4%.
As demonstrated in a recent post, the revision rate increases with time after shoulder arthroplasty. Male gender (the patient) and rotator cuff disease (the problem) increased the risk of revision.
From this plot, it can be seen that the revision rate increases about 1% per year. Thus in comparing studies it is important to consider the annualized revision rate so that a 10 year revision rate of 10% can be seen to be comparable to a 5 year revision rate of 5%.
Revision surgery is a 'hidden' cost of shoulder arthroplasty. For example if the cost of a revision surgery is $20,000 and 10% of shoulder arthroplasties require revision after 10 years, then $2000 is added to the cost of each shoulder arthroplasty.
Taking the view of the 4 Ps, patients, problems (diagnoses), physicians (surgeons), and procedures associated with lower revision rates will be lest costly, other things being equal.
To learn more about shoulder arthritis and what can be done about it, see the Shoulder Arthritis Book.
To learn more about the rotator cuff, see the Rotator Cuff Book
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