Trends – what do the registries tell us?

Swedish registry example

Anders NordqvistMD, PhD, Associate professor

Skane University HospitalMalmö

Sweden

The swedish shoulder arthroplasty registry

• Property of the Swedish shoulder and elbow society• Started in 1999• Administrated by

Björn Salomonsson, MD, PhD,

Danderyd Hospital, Stockholm, Sweden

• Board appointed by the Swedish shoulder and elbow society:Hans Rahme, MD, PhD, Uppsala Sweden

Anders Nordqvist, MD PhD, Malmö SwedenHenrik Ahlborg, MD, PhD, Malmö, SwedenAnders Ekelund, MD, PhD, Stockholm, SwedenBjörn Salomonsson, MD, PhD, Stockholm, Sweden

The swedish shoulder arthroplasty registry

• Started in 1999• Almost all Swedish hospitals participate.• Located at a major Swedish data center

in Lund, Sweden• > 90% of all swedish shoulder

arthroplasties are reported

Swedish shoulder arthroplasty registry 2011

• > 8100 primary reports since 1999

• > 600 (8 %) were re-operations.

• About 1000 reports yearly – covers >90%

News 2011

• Webbased report function.

• SITHS card authorisation of user.

• New database at RCSyd.

• New possibilities for analyse.

The swedish shoulder arthroplasty registry

Primary report:• Primary and revision arthroplasties• Diagnosis• Arthroplasty concept• Name of prosthesis • Surgical method• Complications• WOOS score – some shoulder units

The swedish shoulder arthroplasty registry

• Revision surgery reported• 1 year, 5 years and 10 years follow-up

with self-evaluated score• WOOS score• EQ-5D

Registered Swedish shoulder arthroplasties 1999 – 2011

Annual reports

Hemi-arthroplasty

• Degenerative or post traumatic conditions

• Displaced 3-4 part fractures of the proximal humerus

Hemi-arthroplasties (HHR)Annual reports

Hemi-arthroplasty

• Traditional hemi-arthroplasty with stemmed prosthesis

last years also short stem prosthesis

• Bi-polar arthroplasty

• Resurfacing prosthesis

Hemi-arthroplasties 1999 – 2011(Fracture prosthesis excluded)

Anatomical total shoulder arthroplasty

Traditional total shoulder arthroplasty as originally described by Neer

Requires a stable shoulder with well functioning rotator cuff

More technically demanding for the surgeon than hemiarthroplasty

Anatomical total shoulder arthroplasty (TSR)1999 – 2011

Annual reports

Results 2009

• Of the 2666 primary reports during 1999-2004 – 57% answered. – 20% was dead (or lost address).– 23% did not answer.

• The 5 year WOOS was analysed.

Results WOOS 5 year

Rheumatoid arthritis

– HSA (n = 187) had WOOS 61% – TSA (n = 37) had WOOS 70%

• Bipolar HSA (n = 15) had 57%.• p<0,05 between TSA and HSA

Osteoarthrosis

– HSA (n = 180) had WOOS 68% – TSA (n = 92) had WOOS 83%,

• Resurfacing HSA (n = 18) WOOS 67%– p<0,001 between TSA and HSA

Revisions 2009

Among 637 reported re-operations, we had the index-operation in the register for 218 shoulders. Of these– 62 shoulders OA– 41 shoulders RA

Revisions until 2009

Osteoarthritis 1999-2009 (n=2625)– HSA: 37 revisions for Glenoid / 1311 (2,8%)– TSA: 3 revisions for Glenoid / 852

(0,4%)

Rheumatoid arthritis 1999-2009 (n=1070)– HSA: 16 revisions for Glenoid / 634 (2,5%)– TSA: 2 revisions for Glenoid / 192

(1%)• Bipolar: 3 revisions for Glenoid / 39 (8%)

Reverse total shoulder arthroplasty

• Delta reverse shoulder arhroplasty described by Grammont 1993

• Anders Ekelund in Stockholm started to evaluate the prosthesis in Sweden

• During the last 5 – 10 years more frequent used at the major shoulder centers in Sweden

• More complex cases

Reverse shoulder arthroplasties in Sweden 1999 – 2011

Annual reports

Reverse total shoulder arthroplasty in Sweden 1999 - 2011

• 1999 – 2007 almost all reverse shoulder arthoplasties were Delta 3

• Since 2007 most reverse shoulder arthroplasties were Delta Xtend but during the last years other prosthesis also have been reported

Reverse total shoulder arthroplasty in Sweden 1999 – 2011

Indications

• Rotator cuff arthropathy• Osteoarthrosis• Rheumatoid arthritis• Acute fracture• Sequele after fracture• Revision arthroplasty

Reverse shoulder arthroplasties in Sweden 1999 - 2011

Annual reports

Revision surgery 1999 – 2011Annual reports

Summary: Trends 1999 – 2011

Hemiarthroplasty (HHR), anatomical total shoulder arthroplasty (TSR) and reverse shoulder arthroplasty

Shoulder arthroplasty trends – what do the registries tell us?

Swedish registry exampleConclusions:

• There is a marked increase of shoulder arthroplasties in Sweden from 1999 – 2011

• Hemiarthroplasties show a modest increase. Resurfacing arthroplasties have decreased and short stem arthroplasties have increased instead.

• There is a significant increase of both anatomical and reverse total shoulder arthroplasties.

• Cuffarthropathy, revision cases, fracture sequele aswell as acute fractures are treated with reverse shoulder arthroplasty