The experience of the RIPO, a shoulder prosthesis registry with 6-year follow-up

2006

Objective. Longitudinal trends in epidemiology and utilization of total shoulder arthroplasty (TSA) have not been previously reported. We evaluated trends in the distribution of age, race, hospital volume and teaching status, outcomes, and indications for TSA during the last decade. Methods. TSA cases (n ‫؍‬ 12,758) were extracted from the 1990 -2000 Nationwide Inpatient Sample databases. TSA trends were obtained for 3 time periods: were minor increases in the rate of TSA in most age groups. Ninety-three percent of the patients undergoing TSA in all 3 time periods were white. An increased proportion of patients were operated on in high volume hospitals in period III as compared with period I. Patients discharged to inpatient rehabilitation facilities after surgery had longer lengths of in-hospital stays as compared with those discharged home. Osteoarthritis was diagnosed in an increasing proportion of patients undergoing TSA (56.6% in period I versus 70.9% in period III). Conclusion. There was a minor increase in the rate of TSA, and almost no change in use of TSA by nonwhites from 1990 through 2000. Efforts to understand and narrow this apparent underutilization of TSA among nonwhites are required. Further research should determine whether the observed shift of TSA to high volume centers improves surgical outcomes.

Purpose Revision of a shoulder arthroplasty to a reverse arthroplasty is a highly demanding procedure. The aim of this study is to report the clinical results of hemi and total shoulder prosthesis revisions to reverse implants without removal of the humeral stem, using a modular shoulder replacement system (SMR Lima LTD). We retrospectively reviewed 26 patients who underwent an operation from 2004 to 2009. Methods The patients were divided into two groups: in Group I, 18 patients underwent a revision of hemiarthroplasty implanted for fracture; in Group II, eight patients underwent a revision of anatomical total prosthesis. All patients were evaluated at a mean follow-up of 32.3 (±12.7) months using the Constant score rating scale and by range of motion evaluation , EQ-VAS, X-ray and CT scan. Results The Constant score of each patient was 47.88 (±5.88) after the revision. The EQ-VAS improved from 40 (±20) to 70 (±10). All patients improved in terms of range of motion. The radiographs and CT scans obtained after revision showed good integration and no signs of loosening of the implant. The mean time of surgery was recorded as 62′ (±8′), with a maximum blood loss of less than 300 ml in all cases. Conclusions Our study demonstrates that using a full modular system at the time of the first implant allows avoidance of the step to remove the humeral stem and metal back in cases of shoulder prosthesis revision to a reverse prosthesis, resulting in a short operative time, few intraoperative complications and a satisfactory clinical outcome at medium-term follow-up.

JSES Open Access

Background: Indications for reverse total shoulder arthroplasty (RTSA) have expanded. The purpose of this retrospective cohort study was to evaluate national trends in shoulder arthroplasty utilization and to compare national perioperative complication rates for hemiarthroplasty (HA), total shoulder arthroplasty (TSA), and RTSA in a matched cohort. Methods: The National Inpatient Sample was queried from 2011-2013 to identify patients who underwent HA, TSA, or RTSA. Age, sex, race, insurance type, Elixhauser comorbidity index, and perioperative complications were identified. A coarsened exact matching algorithm was used to match RTSA patients with TSA and HA patients to compare medical and implant-related perioperative in-hospital complications. Multivariable logistic regression analysis was performed on unmatched data to identify risk factors for development of perioperative complications. Results: Overall, 42,832 shoulder arthroplasties were identified (44% TSAs, 34% RTSAs, 19% HAs). After matching, RTSAs had 6.2 times the odds of a perioperative implant-related complication (P < .001) and 2 times the odds of a red blood cell transfusion compared with TSAs (P < .001). The logistic regression model showed that prior shoulder arthroplasty (odds ratio [OR], 15.1; P < .001), younger age (OR, 0.98; P ¼ .006), earlier year of index surgery (OR, 0.83; P ¼ .002), history of illicit drug use (OR, 6.2; P ¼ .008), and depression (OR, 2.3; P ¼ .003) were risk factors for development of in-hospital implant-related complications after RTSA. Conclusion: The perioperative implant-related complication rate and postoperative transfusion rate of RTSAs were significantly higher than those of TSAs. In addition, prior shoulder surgery, younger age, earlier year of index surgery, history of illicit drug use, and depression were risk factors for implantrelated complications after RTSA. However, the perioperative RTSA implant-related complications did decline each year, suggesting a growing national proficiency with performing RTSA.

Seminars in Arthroplasty, 2015

As total shoulder arthroplasty has become more popular, the number of complications and failures are increasing. Surgeons performing the procedure and patients considering the surgery need to understand the factors that may determine success or failure. The most common predictors of failure are the indication for surgery (patient factors), the type of implant used (arthroplasty implant factors), and the skill of the surgeon (surgical factors). The aim of this review is to delineate the factors that may be associated with an increase in the risk of total shoulder arthroplasty failure.

Journal of Physical Medicine Rehabilitation Studies & Reports, 2020

Historically, reverse shoulder arthroplasty (RSA) has been reserved for elderly patients. Patients younger than 55 requiring RSA are challenging as they live longer, place more stress and wear on implants, and have higher reoperation rates compared to patients older than 55 years of age. Our goal was to examine the survivorship and functional outcomes of patients younger than 55 years old undergoing RSA. Patients younger than 55 years old who underwent RSA with a minimum two year follow-up were retrospectively reviewed. We evaluated implant survivability, postoperative American Shoulder and Elbow Surgeons (ASES) score, etiology of surgery, and medical demographic data. 29 RSA were performed on 22 patients (7 were bilateral). 20 of the 29 shoulders (68.9%) had a minimum two year follow up and were included for data analysis. Indications for RSA in our patients included: cuff tear arthropathy (14), post-traumatic arthritis (7), rheumatoid arthritis (3), primary osteoarthritis (3), and...

Scandinavian Journal of Rheumatology, 2006

Objective: To provide estimates of patient outcomes following shoulder arthroplasty using Neer-II type humeral prosthesis and to examine variation in outcomes due to patient and prosthesis characteristics. Methods: North American and Western European published articles were identified through a computerized literature search and bibliography review. Studies were included if they enrolled 15 or more patients, discriminated between hemi-arthroplasty (HEMI) and total shoulder arthroplasty (TSA) and measured pain relief, gain in range of motion (ROM), radiographic follow-up (w2 years), short-and long-term complications, and revision surgery. Results: A total of 40 studies satisfied the inclusion criteria. The total number of patients enrolled was 3584. The mean follow-up was 59 months. The mean patient age was 62 years, 65% of patients were women and 73% underwent TSA. All reports showed relevant pain relief, increase in ROM, and high satisfaction rates for HEMI and TSA in both osteoarthritis (OA) and rheumatoid arthritis (RA). The overall rate of revision was 8%. Significant differences between HEMI and TSA for both diagnoses were found for all outcome parameters. Conclusion: Shoulder arthroplasty is a safe and effective procedure for OA and RA patients. The diagnosis, shoulder pathology, and prosthesis specifics were significant predictors of outcomes. We therefore emphasize that conclusions on the outcome of shoulder arthroplasty can only be made if differentiated between these patient and prosthesis specifics. Limitations in the reporting style of these articles severely constrain the ability to explore variation in outcomes due to study, patient, or prosthesis characteristics and restrict their generalisability.

BMJ Open, 2020

PurposeClinical registries are essential for evaluation of surgical outcomes. The Schulthess Shoulder Arthroplasty Registry (SAR) was established in 2006 to evaluate safety, function, quality-of-life and patient satisfaction in patients undergoing shoulder arthroplasty.ParticipantsAdult patients undergoing anatomic or reverse shoulder joint replacement at the Schulthess Klinik, a high-volume, leading orthopaedic surgery centre in Zürich, Switzerland.Findings to dateBetween March 2006 and December 2019, the registry covered 98% of eligible operations. Overall, 2332 patients were enrolled with a total of 2796 operations and 11 147 person-years of follow-up. Mean age at baseline was 71 (range: 20–95), 65% were women. Most common indication was rotator cuff tears with osteoarthritis (42%) and the mean preoperative Constant Score was 31 (±15). The most frequent arthroplasty type was reverse, increasing from 61% in 2006–2010 to 86% in 2015–2019. Functional recovery peaked at 12-month post...

Journal of Clinical Medicine

The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 an...

BMC Musculoskeletal Disorders

Background Shoulder replacement (SR) constitutes the gold standard treatment for severe shoulder diseases, including osteoarthritis, rheumatoid arthritis, complex fractures, avascular necrosis and rotator cuff arthropathy. Although several countries have national registries, there is a lack of epidemiological data on SR. Sharing national statistics and correlating those to other countries could be helpful to compare outcomes and costs internationally. This paper aims to evaluate the trend of hospitalizations for SR (both first implants and revisions of anatomical and reverse prosthesis) in Italy from 2009 to 2019, based on the National Hospital Discharge Reports (S.D.O) provided by the Italian National Health Service (INHS). Moreover, the economic impact on the healthcare system of SR and SR revisions was assessed, providing a statistical prediction for the next ten years. Methods The data used in this paper were about patients who underwent Total Shoulder Replacement (TSR), Shoulde...

Japan Shoulder Society combined with The 1st Asia-Pacific Shoulder & Elbow Symposium, 2017

Background: No studies compare outcomes of anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty with more than five-year follow-up. Methods: A multicenter prospectively collected shoulder registry was utilized to review all patients undergoing primary anatomic total shoulder arthroplasty or primary reverse total shoulder arthroplasty with a minimum five-year follow-up utilizing a single platform stem implant system. One-hundred-ninety-one patients received an anatomic total shoulder arthroplasty and 139 patients received a reverse total shoulder arthroplasty. Patients were scored preoperatively and at latest follow-up using the simple shoulder test (SST), University of California Los Angeles (UCLA), American shoulder and elbow surgeons (ASES), Constant, and shoulder pain and disability index (SADI) scores as well as range of motion. Radiographs were evaluated for implant loosening or notching. Complications were reviewed. A Student's two-tailed, unpaired t-test identified differences in preoperative, postoperative, and pre-to-postoperative improvements. Results: Reverse total shoulder arthroplasty patients were significantly older than anatomic total shoulder arthroplasty patients. All patients demonstrated significant improvement in functional metric scores and range of motion following anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty. There was no difference in final outcome scores between anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients at midterm followup; however, reverse total shoulder arthroplasty patients demonstrated significantly less motion. Discussion: We demonstrate equivalent outcomes with five scoring metrics at mean follow-up of 71.3 AE 14.1 months. Although postoperative scores were significantly greater than preoperative scores for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients, significant differences in outcome scores between cohorts were not observed.

Journal of Shoulder and Elbow Surgery, 2015

Background: Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are increasingly common procedures employed to treat arthritic conditions. Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff, concerns about RTSA persist because of variable complication rates and outcomes. Methods: This is a prospective, case-control study comparing outcomes and complications after TSA and RTSA. The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy. Average clinical follow-up was more than 2 years in both groups. Major complications included infection, periprosthetic fracture, instability, glenoid loosening, and need for revision surgery. Patient outcome measures included the American Shoulder and Elbow Surgeons score, pain visual analog scale score, and goniometer-measured range of motion. Plain radiographs were reviewed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA. Results: At 2 years, there were no differences in rate of major complications (TSA, 15%; RTSA, 13%; P ¼ .808) or revision surgeries (TSA, 11%; RTSA, 9%). Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups. TSA patients had greater external rotation than RTSA patients did (53 vs 38 ; P ¼ .001). Otherwise, forward flexion, abduction, and internal rotation were comparable in range of motion. Conclusions: TSA and RTSA have similar complication rates, need for revision, patient-reported outcomes, and range of motion at 2 years of follow-up. The use of side-by-side cohorts in this study allows standardized comparison between these 2 shoulder arthroplasty procedures.

Journal of Clinical Medicine, 2022

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

European Journal of Radiology, 2008

Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 • in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and "bone stock", prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 • of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

Journal of Shoulder and Elbow Surgery, 2002

Failure of shoulder arthroplasty is often defined as a complication or the need for revision, but it may also be viewed as a result that does not meet the expectations of the patient. To enhance our understanding of failed shoulder arthroplasties, we identified the characteristics common to a series of 139 consecutive patients who came to our shoulder consultation service because of dissatisfaction with the result of their shoulder arthroplasty. Primary osteoarthritis (28%) and proximal humeral fractures (26%) were the most common indications for the initial arthroplasty. Seventythree shoulders (fifty-two percent) had at least one surgery before arthroplasty was performed. Seventy-four percent of the shoulders were stiff, 35% were unstable, and in the total shoulders, 59% of the glenoids were loose. Components were substantially malpositioned in 23%. Forty-two percent of shoulders with a failed hemiarthroplasty had substantial glenoid erosion, and 43% of shoulders that had undergone a hemiarthroplasty for fracture had nonunion of the tuberosities. Patients demonstrated impaired shoulder function; on average, they could perform only 2 of 12 shoulder functions. The rate of revision underestimated the rate of failure, as 23% of arthroplasties did not undergo revision. The challenge of achieving patient satisfaction after arthroplasty may be greater than previously recognized. Many of these unsatisfactory shoulder arthroplasties did not meet the criteria for failure used in previously published series. These observations suggest that greater attention to achieving proper component position, postoperative motion, and in fracture cases, fixation of the tuberosities may lead to increased patient satisfaction after shoulder arthroplasty.

Journal of Shoulder and Elbow Surgery, 2012

Background: The aim was to review the funding, organization, data handling, outcome measurements, and findings from existing national shoulder and elbow joint replacement registries; to consider the possibility of pooling data between registries; and to consider wether a pan european registry might be feasible. Materials and methods: Web sites, annual reports, and publications from ongoing national registries were searched using Google, PubMed, and links from other registries. Representatives from each registry were contacted. Results: Between 1994 and 2004, 6 shoulder registries and 5 elbow registries were established, and by the end of 2009, the shoulder registries included between 2498 and 7113 replacements and the elbow registries between 267 and 1457 replacements. The registries were initiated by orthopedic societies and funded by the government or by levies on implant manufacturers. In some countries, data reporting and patient consent are required. Completeness is assessed by comparing data with the national health authority. All registries use implant survival as the primary outcome. Some registries use patient-reported outcomes as a secondary outcome. Conclusions: A registry offers many advantages; however, adequate long-term funding and completeness remain a challenge. It is unlikely that large-scale international registries can be implemented, but more countries should be encouraged to establish registries and, by adopting compatible processes, data could be pooled between national registries, adding considerably to their power and usefulness. Investigational Review Board approval was not required for this article.