Transcript The Swedish Shoulder Arthroplasty Register

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:
 Designe
 Technique
 Diagnose
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)
Re-operation
7%
Primary arthroplasty
93%
COMMON DIAGNOSIS
The most common diagnoses
1328
1400
1200
911
1000
717
800
600
400
200
0
Reumatoid
Arthrosis
Fracture
The Swedish Shoulder
Arthroplasty Register.
1999-2006
5year follow-up by WOOSscore 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
Number of Primary 1999-2001
1400
1200
1000
Replies
800
1999-2001
1238
600
400
616
200
0
1
2
5-YEAR WOOS F.U.
5-year follow-up
Deceased
15%
Missing
5%
Mail
80%
5-YEAR WOOS REPLY
Mail 5-year follow-up
No reply
38%
Reply
62%
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
WOOS % 5-year MALE / FEMALE
80
70
60
50
73,5
40
62
30
20
10
0
1
2
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
WOOS % / Diagnos 5 år
80
70
60
50
79
40
30
20
54
58
62
65
66
38
10
0
Non union
Caputnecrosis
Cuff-arthrop
Reumatoid
Fracture
Secondary
Arthrosis
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
5-year WOOS HEMI / TOTAL
81
90
80
64
70
60
50
40
30
20
10
0
Hemi arthroplasty
Total arthroplasty
5-YEARS SATISFACTION
One question on patient satisfaction after
5 years was also asked.
5-YEARS SATISFACTION
Satisfaction 5-Years F.U.
40%
34%
35%
30%
30%
26%
25%
29%
27%
23%
All Hospitals
20%
> 20 (n=16)
17% 17%
14% 14%
15%
15%
< 20 (n=26)
16%
13%
12%
13%
10%
5%
0%
Very satisfied
Satisfied
Either
Not satisfied
dissatisfied
5-YEARS SATISFACTION
All / Danderyd Hospital
35%
33%
30%
30%
30%
26%
25%
20%
17%
All Hospitals
17%
Danderyd (n=54)
15%
14%
13%
13%
10%
7%
5%
0%
Very satisfied
Satisfied
Either
Not satisfied
dissatisfied
5-YEARS WOOS/HOSPITAL
WOOS / Hospital > 10 Answers
80%
70%
60%
50%
WOOS
40%
WOOS>25
30%
20%
10%
0%
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
5-YEARS WOOS/IMPLANT
Implant WOOS
1
0,9
0,8
72%
0,7
72%
66%
65%
65%
61%
60%
0,6
WOOS >20
0,5
WOOS >50
0,4
0,3
0,2
0,1
A
is
al
l l)
ie
rn
To
ng
ti
ot
r
h
A
am
eq
u
(A
ee
N
ba
G
lo
w
to
la
-F
ni
lia
B
ig
N
n
at
om
3
ic
M
al
m
/S
od
ul
ul
ze
r
ar
l
r2
0
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