trends – what do the registries tell us? swedish registry example
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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 - PowerPoint PPT PresentationTRANSCRIPT
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Trends – what do the registries tell us?
Swedish registry example
Anders NordqvistMD, PhD, Associate professor
Skane University HospitalMalmö
Sweden
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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 SwedenAnders Nordqvist, MD PhD, Malmö SwedenHenrik Ahlborg, MD, PhD, Malmö, SwedenAnders Ekelund, MD, PhD, Stockholm, SwedenBjörn Salomonsson, MD, PhD, Stockholm, Sweden
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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
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Swedish shoulder arthroplasty registry 2011
• > 8100 primary reports since 1999• > 600 (8 %) were re-operations.• About 1000 reports yearly
– covers >90%
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News 2011
• Webbased report function. • SITHS card authorisation of user.• New database at RCSyd.• New possibilities for analyse.
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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
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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
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Registered Swedish shoulder arthroplasties 1999 – 2011
Annual reports
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Hemi-arthroplasty
• Degenerative or post traumatic conditions
• Displaced 3-4 part fractures of the proximal humerus
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Hemi-arthroplasties (HHR)Annual reports
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Hemi-arthroplasty
• Traditional hemi-arthroplasty with stemmed prosthesis
last years also short stem prosthesis
• Bi-polar arthroplasty
• Resurfacing prosthesis
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Hemi-arthroplasties 1999 – 2011(Fracture prosthesis excluded)
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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
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Anatomical total shoulder arthroplasty (TSR)1999 – 2011
Annual reports
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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.
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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
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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
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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%)
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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
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Reverse shoulder arthroplasties in Sweden 1999 – 2011
Annual reports
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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
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Reverse total shoulder arthroplasty in Sweden 1999 – 2011
Indications
• Rotator cuff arthropathy• Osteoarthrosis• Rheumatoid arthritis• Acute fracture• Sequele after fracture• Revision arthroplasty
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Reverse shoulder arthroplasties in Sweden 1999 - 2011
Annual reports
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Revision surgery 1999 – 2011Annual reports
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Summary: Trends 1999 – 2011
Hemiarthroplasty (HHR), anatomical total shoulder arthroplasty (TSR) and reverse shoulder arthroplasty
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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