ABSTRACT
AIMS: The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to infection after reverse shoulder arthroplasty. PATIENTS AND METHODS: We included 17 730 primary shoulder arthroplasties recorded between 2004 and 2013 in The Nordic Arthroplasty Register Association (NARA) data set. With the Kaplan-Meier method, we illustrated the ten-year cumulative rates of revision due to infection and with the Cox regression model, we reported the hazard ratios as a measure of the relative risk of revision due to infection. RESULTS: In all, 188 revisions were reported due to infection during a mean follow-up of three years and nine months. The ten-year cumulative rate of revision due to infection was 1.4% overall, but 3.1% for reverse shoulder arthroplasties and 8.0% for reverse shoulder arthroplasties in men. Reverse shoulder arthroplasties were associated with an increased risk of revision due to infection also when adjusted for sex, age, primary diagnosis, and year of surgery (relative risk 2.41 (95% conï¬dence interval 1.26 to 5.59); p = 0.001). CONCLUSION: The overall incidence of revision due to infection was low. The increased risk in reverse shoulder arthroplasty must be borne in mind, especially when offering it to men. Cite this article: Bone Joint J 2019;101-B:702-707.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/surgery , Reoperation/statistics & numerical data , Aged , Denmark/epidemiology , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Norway/epidemiology , Prosthesis Failure , Registries , Risk Factors , Sweden/epidemiologyABSTRACT
OBJECTIVE: To report the10-year survival rates of different shoulder arthroplasty types used for glenohumeral osteoarthritis. DESIGN: Data from 2004 to 2013 was prospectively collected by the national shoulder arthroplasty registers in Denmark, Norway and Sweden and merged into a harmonized dataset under the umbrella of the Nordic Arthroplasty Register Association. The common dataset included data that all three registers could deliver and where consensus regarding definitions could be made. Revision was defined as removal or exchange of any component or the addition of a glenoid component. RESULTS: The cumulative survival rates at 10 years after resurfacing hemiarthroplasty (RHA) (n = 1,923), stemmed hemiarthroplasty (SHA) (n = 1,587) and anatomical total shoulder arthroplasty (TSA) (n = 2,340) were 0.85, 0.93 and 0.96 respectively (P < 0.001, Log rank test). RHA (HR: 2.5; CI 1.9-3.4, P < 0.001) and SHA (HR: 1.4; CI 1.0-2.0, P < 0.04) had an increased risk of revision compared to TSA. Gender, age and period of surgery were included in the Cox regression model. For patients below 55 years, the 10-year cumulative survival rates were 0.75 (RHA, n = 354), 0.81 (SHA, n = 146), and 0.87 (TSA, n = 201). CONCLUSIONS: Anatomical TSA had the highest implant-survival rate. Young patients had, independently of the arthroplasty type, lower implant-survival rates. The treatment of young patients with end-stage osteoarthritis remains a challenge.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Hemiarthroplasty/methods , Osteoarthritis/surgery , Range of Motion, Articular/physiology , Registries , Shoulder Joint/surgery , Aged , Denmark/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Norway/epidemiology , Osteoarthritis/mortality , Osteoarthritis/physiopathology , Reoperation , Retrospective Studies , Shoulder Joint/physiopathology , Survival Rate/trends , Sweden/epidemiology , Time FactorsABSTRACT
Two new national orthopedic quality registers were started in Sweden in 1999, the Swedish Shoulder Arthroplasty Register and the Swedish Elbow Arthroplasty Register. Both are owned by the Swedish Shoulder and Elbow Section of the Swedish Orthopedic Association. The purpose of the registers is to improve surgical techniques and selection of implants and identify individual risk factors. Two of the main problems in starting a new national quality register involve inducing all centers in the country to participate and deciding on the data to register.
Subject(s)
Arthroplasty, Replacement , Elbow Joint , Joint Diseases/surgery , Registries , Shoulder Joint , Arthroplasty, Replacement/instrumentation , Humans , Joint Diseases/epidemiology , Orthopedics , Societies, Medical , SwedenSubject(s)
Fracture Fixation/adverse effects , Joint Instability/complications , Orthopedic Procedures/methods , Shoulder Dislocation/complications , Tendon Injuries , Tendons/surgery , Accidental Falls , Fracture Fixation/methods , Humans , Joint Instability/diagnosis , Joint Instability/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Shoulder Dislocation/diagnosis , Shoulder Dislocation/surgery , Time Factors , Treatment Outcome , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/surgeryABSTRACT
This study consists of 27 shoulders in 24 patients whose atraumatic shoulder instability was treated with the imbrication procedure described by Rockwood. Follow-up after 2 years or more showed the following results: 37% excellent, 30% good, 15% fair and 18% poor (Rowe score). No statistically significant differences in the results were observed between the dominant and non-dominant arm, nor in post-operative return to sports activities. Those with voluntary instability had more laxity at follow-up and tended to have poorer results. Those with unidirectional laxity had only good or excellent results and showed no post-operative laxity. We found no other reliable indication of the results of surgery. The difficulties of classifying shoulder instability by such factors as trauma, laxity and direction of instability are discussed. Overall, we consider capsular imbrication to be a good treatment for involuntary atraumatic shoulder instability.
