The Swedish Shoulder Arthroplasty Register.

1999-2006

5-year follow-up by WOOS-score in 616 primary shoulder

arthroplasties.

1999-2006

Experiences after 8 years

Ulf Lillkrona Anders Nordqvist

Hans Rahme Björn Salomonsson

The Swedish Shoulder and Elbow Society´s, Board of Quality Registers

THE REGISTER

• It is owned by SSAS.• Will change plattform to

get an internet report solution. • Cooperation with the

NKO.

REGISTER AIM:

• Earlier identification of problems.• Obtain results for:

DesigneTechniqueDiagnose

REPORTS

• Simple, 2 minutes. (Internet in 2007)• 5-year follow-up by

mail. • WOOS, EQ-5D.

WOOS-SCORE

• Well documented.• Diagnose-specific.• Patient self-evaluating.• Validation in Swedish.• The same score in

Denmark.

PROBLEMS

• Missing information <5%• Missing reports <10%

Trauma-surgeons?Local organisation!Uncertain comparison!

• 2 Hospitals do not report!

REPORTS -2006

Total 3871 reports (255 / 3616)

Primary arthroplasty93%

Re-operation7%

COMMON DIAGNOSIS

717

911

1328

0

200

400

600

800

1000

1200

1400

Reumatoid Arthrosis Fracture

The most common diagnoses

The Swedish Shoulder Arthroplasty Register.

1999-2006

5year follow-up by WOOS-score in 616 primary

shoulder arthroplasties.

AIM:

• To examine the functional outcome of primary shoulder arthroplasties that were reported to the Swedish National Registry.

• This was conducted as a self evaluation with a WOOS-score.

• 5 years after surgery.

MATERIAL:

• All patients with a report of a shoulder arthroplasty to the Swedish National Registry is asked to complete a WOOS score 5 years after the reported surgery.

• The registry started in 1999, and until 2001, 1238 primary shoulder arthroplasties were reported.

5-YEAR WOOS-SCORE REPLY

1238

616

0

200

400

600

800

1000

1200

1400

1 2

Number of Primary 1999-2001

Replies

1999-2001

5-YEAR WOOS F.U.

5-year follow-up

Deceased15%

Missing5%

Mail80%

5-YEAR WOOS REPLY

Mail 5-year follow-up

Reply62%

No reply38%

5 YEAR WOOS-SCORE

• 616 patients from 42 different hospitals completed the mailed WOOS-score and returned it to the register by mail during 2004-2006.

• The WOOS score i presented as a percentage of a normal shoulder function.

RESULTS:

• The WOOS score was calculated for different patient selections.

• Males were fewer (n=170) but had a higher median WOOS score of 73,5% compared to females (n=446) 62%.

5-YEAR WOOS GENDER

73,5

62

0

10

20

30

40

50

60

70

80

1 2

WOOS % 5-year MALE / FEMALE

RESULTS:

• Nonunion n=15, WOOS 38%• Osteonekrosis n=20, WOOS 53,5%• Cuff arthropaty n=24, WOOS 57,5%• Reumatoid arthritis n=146, WOOS 62%• Fractures n=197, WOOS 65%• Secondary arthrosis n=31, WOOS 66%• Osteoarthrosis n=141, WOOS 79%

5 YEAR WOOS DIAGNOSE

38

5458

6265 66

79

0

10

20

30

40

50

60

70

80

Non union Caputnecrosis Cuff-arthrop Reumatoid Fracture Secondary Arthrosis

WOOS % / Diagnos 5 år

Serie1

RESULTS:

• Comparing different concepts by the median WOOS score:

• Hemi arthroplasty (n=516, WOOS 64%)

• Total arthroplasty (n=75, WOOS 81%)

5 YEAR WOOS HEMI / TOTAL

64

81

0

10

20

30

40

50

60

70

80

90

Hemi arthroplasty Total arthroplasty

5-year WOOS HEMI / TOTAL

5-YEARS SATISFACTION

One question on patient satisfaction after 5 years was also asked.

5-YEARS SATISFACTION

Satisfaction 5-Years F.U.

26%

30%

14%

17%

13%

27%

29%

14%

17%

12%

23%

34%

15%16%

13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Very satisfied Satisfied Either Not satisfied dissatisfied

All Hospitals

> 20 (n=16)

< 20 (n=26)

5-YEARS SATISFACTION

All / Danderyd Hospital

26%

30%

14%

17%

13%

33%

30%

7%

17%

13%

0%

5%

10%

15%

20%

25%

30%

35%

Very satisfied Satisfied Either Not satisfied dissatisfied

All HospitalsDanderyd (n=54)

5-YEARS WOOS/HOSPITAL

WOOS / Hospital > 10 Answers

0%

10%

20%

30%

40%

50%

60%

70%

80%

A B C D E F G H I J K L M N O P Q R S T U V X Y Z A B C

WOOS

WOOS>25

5-YEARS WOOS/IMPLANT

Implant WOOS

66%

72%

61%

72%

65% 65%60%

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

1

3M modular

Anatomical/SulzerBigliani-Flatow

Global Neer2

Nottingham (All) Tornier Aequalis

WOOS >20

WOOS >50

IMPLANTS

• A majority of the implants used at the beginning 1999 now is out of market or has a changed design 2007.

CONCLUSION:

• The Swedish Shoulder Arthroplasty Register now is beginning to produce results from a 5 year follow-up.

• The follow-up rate of 50% is not yet enough, but the results will still be able to give an indication of what result to expect from a shoulder arthroplasty in different patient selections.

FURTHER ANALYSIS:

• Analysis will also be made between different implants and hospitals in the next years.

• Change in design of the implants will result in new entities for the analysis.

Thank you!

www.ssas.se

www.ssas.se/axel