Low arthroplasty survival after treatment for proximal humerus fracture sequelae: 3,245 shoulder replacements from the Nordic Arthroplasty Register Association

Abstract

Background and purpose Proximal humerus fractures (PHF) may result in sequelae indicating arthroplasty. We report cumulative survival rates and reasons for revision after arthroplasty for proximal humerus fracture sequelae (PHFS). Patients and methods Data were derived from the Nordic Arthroplasty Register Association. The Kaplan– Meier method was used to illustrate survival rates. A scaled Schoenfeld residual plot was used to report the risk of revision for men relative to women in patients who were treated with reverse shoulder arthroplasty (RSA). Revision was defined as removal or exchange of any component or the addition of a glenoid component. Results 30,190 primary arthroplasties were reported from 2004 to 2016, of which 3,245 were for PHFS. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 96% (95–97), 90% (89–92), and 86% (83–88) for stemmed hemiarthroplasty and 94% (92–95), 89% (87–91), and 86% (82–90) for RSA with a median time to revision of 18 months (IQR 9–44) and 3 months (IQR 0–17). The risk of revision for men relative to women in patients who were treated with RSA was 3.2 (1.9–5.1) 0–1 year after surgery and 1.9 (0.9–4.1) 1–8 years after surgery. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 94% (92–96), 88% (85–90), and 80% (75–86) for men and 95% (94–96), 86% (84–89), and 81% (77–84) for young patients. Interpretation Shoulder arthroplasty for PHFS was associated with lower survival rates, compared with previously published results of shoulder arthroplasty for acute PHF. The low arthroplasty survival rates for men and young patients especially are worrying.

CORR Insights®: Is D-dimer a Reliable Serum Marker for Shoulder Periprosthetic Joint Infection?

“…While registries are inadequate for identifying asymptomatic colonized patients, they are excellent tools for collecting large datasets of less frequently performed surgeries. One example is a recent analysis of more than 3000 shoulder replacements from the Nordic Arthroplasty Register Association, which raised concerns over lower-than-previously-reported arthroplasty survival among men undergoing shoulder arthroplasty due to proximal humerus fracture sequelae [9]. Registries should include some additional information on how the diagnosis of shoulder PJI was determined in the first place.…”

Revision Rates and Associated Risk Factors after Shoulder Arthroplasty

“…Importantly, with the increasing performance of shoulder arthroplasty procedures, also the risk of complications such as periprosthetic joint infection is heightened. A few studies reported revision rates based on large registry data such as the Nordic Arthroplasty Register Association [14][15][16], the Swedish Fracture Register [17] and the Australian Orthopaedic Association National Joint Replacement Registry [18]. However, substantial heterogeneity among studies reporting reoperation rates was noted [19].…”

Locked fracture dislocations of the proximal humerus: postoperative results and a proposed modification of the classification

“…Up to date, several treatment options such as humeral osteotomy, hemiarthroplasty (HA), anatomical total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) have been suggested [ 2 , 3 , 5 , 6 ]. However, the complication rates are reported to be as high as 45% and the long-term survival rates are reported to be worse [ 1 , 7 ]. For TSA recurrent instability and glenoid loosening have been described, whereas the main problem for RSA is reported to be the fixation of the glenoid component [ 2 , 6 ].…”