Transcript Delta Xtend reverse shoulder arthroplasty Indications

Trends – what do the registries tell us?
Swedish registry example
Anders Nordqvist
MD, PhD, Associate professor
Skane University Hospital
Malmö
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 Sweden
Henrik Ahlborg, MD, PhD, Malmö, Sweden
Anders Ekelund, MD, PhD, Stockholm, Sweden
Björn 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
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Webbased report function.
SITHS card authorisation of user.
New database at RCSyd.
New possibilities for analyse.
The swedish shoulder
arthroplasty registry
Primary report:
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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
600
500
400
Hemi Fraktur
300
Hemi elektiv
200
Hemi Alla
100
11
20
09
20
07
20
05
20
03
20
01
20
19
99
0
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)
300
250
Stammad
Hemi
Bipolär
Hemi
Ytersättande
Hemi
CTA-huvud
200
150
100
50
20
11
20
09
20
07
20
05
20
03
20
01
19
99
0
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
500
450
400
350
300
250
200
150
100
50
0
9
20
11
7
20
0
5
20
0
20
0
3
20
0
1
20
0
19
9
9
Totalplastiker
Results 2009
• Of the 2666 primary reports during 19992004
– 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
– TSA (n = 37) had WOOS
• Bipolar HSA (n = 15) had
• p<0,05 between TSA and HSA
Osteoarthrosis
– HSA (n = 180) had WOOS
– TSA (n = 92) had WOOS
• Resurfacing HSA (n = 18) WOOS
– p<0,001 between TSA and HSA
61%
70%
57%.
68%
83%,
67%
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
– TSA: 3 revisions for Glenoid / 852
(2,8%)
(0,4%)
Rheumatoid arthritis 1999-2009 (n=1070)
– HSA: 16 revisions for Glenoid / 634
– TSA: 2 revisions for Glenoid / 192
• Bipolar: 3 revisions for Glenoid / 39
(8%)
(2,5%)
(1%)
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
250
200
150
Omvänd total
100
50
20
11
08
20
05
20
02
20
19
99
0
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
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Rotator cuff arthropathy
Osteoarthrosis
Rheumatoid arthritis
Acute fracture
Sequele after fracture
Revision arthroplasty
Reverse shoulder arthroplasties in
Sweden 1999 - 2011
Annual reports
140
120
100
Cuffartropati
Artros
Reumatisk artrit
Fraktur
Fraktur sequele
80
60
40
20
20
11
9
20
0
7
20
0
5
20
0
3
20
0
1
20
0
19
9
9
0
Revision surgery 1999 – 2011
Annual reports
120
100
Alla
revisioner
80
60
Omvänd
plastik
revision
40
20
20
11
9
20
0
7
20
0
5
20
0
3
20
0
1
20
0
19
9
9
0
Summary: Trends 1999 – 2011
Hemiarthroplasty (HHR), anatomical total shoulder
arthroplasty (TSR) and reverse shoulder arthroplasty
600
Totalplastiker
500
Hemiplastiker
Omvända
plastiker
400
300
200
100
20
11
09
20
07
20
05
20
03
20
01
20
19
99
0
Shoulder arthroplasty trends –
what do the registries tell us?
Swedish registry example
Conclusions:
• 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 as
well as acute fractures are treated with reverse shoulder
arthroplasty