Risk factors for revision surgery after humeral head replacement: 1,431 shoulders over 3 decades

Abstract

Objective Assess long-term risk of revision surgery and its predictors after undergoing humeral head replacement (HHR). Methods We used prospectively collected data from the Mayo Clinic Total Joint registry and other institutional electronic databases. Revision-free survival for HHR at 5-, 10- and 20-years was calculated using Kaplan-Meier survival analysis. We used univariate and multivariable-adjusted Cox regression analyses to examine the association of age, gender, body mass index (BMI), comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologist (ASA) class, implant fixation (cemented versus not) and underlying diagnosis with the risk of revision surgery. Hazard ratio with 95% confidence interval (CI) and p-values are presented. Results 1,359 patients underwent 1,431 shoulder HHRs during the study period, 1976–2008. The average age was 63 years, 63% were female, mean BMI was 28 kg/m2 and 60% implants were cemented. 114 HHRs were revised during the follow-up. At 5-, 10- and 20-years, the shoulder implant survival was 93.6% (95% CI, 92.1%–95%), 90% (95% CI, 88%–92%) and 85% (95% CI, 81.8%–88.4%) respectively. In multivariable-adjusted analyses, older age was associated with lower hazard of revision, hazard ratio, 0.97 (95% CI, 0.96–0.99; p-value<0.001) and higher BMI with higher hazard ratio of 1.04 (95% CI, 1.01–1.08; p-value=0.02). Conclusions Long-term survival of HHR at 20-years was excellent. Obesity and younger age are risk factors for higher revision rate after HHR. Further studies should investigate the biologic rationale for these important associations. Surgeons can discuss these differences in revision risk with patients, especially in young obese patients.

Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England

“… 31 Previous studies have reported unadjusted estimates of revision-free implant survival ranging from 89% to 92% at 10 years. 32 33 34 35 36 These published figures are similar to those found for our study population. The only published 20 year implant survival rates are from one centre (Mayo Clinic, MN) and indicate an 85% survival for 1431 humeral head replacements and 81% for 2588 total shoulder replacements.…”

“…The only published 20 year implant survival rates are from one centre (Mayo Clinic, MN) and indicate an 85% survival for 1431 humeral head replacements and 81% for 2588 total shoulder replacements. 32 33 These estimates are lower than the mean long term implant survival estimates for our study, but the mean age of patients in these studies was 63 and 65 years, respectively; substantially lower than our study mean age of 73 years. The proportion of men was also considerably higher, which might account for the higher reported revision rates.…”

Functional Outcomes After Total Shoulder Arthroplasty in Obese Patients

“…During this follow-up period, no revision of the components was seen in either the overweight group or the obese group. In contrast, Singh et al 38 reported obesity as a risk factor for higher revision rates after humeral head replacements after following a group of patients with >1400 shoulders in a twenty-year follow-up study.…”

Anatomical total shoulder arthroplasty used for glenohumeral osteoarthritis has higher survival rates than hemiarthroplasty: a Nordic registry-based study

“…Information about survival rates of hemiarthroplasty is sparse. A large institutional register study reported 26 revisions (7.5%) in 348 hemiarthroplasties used for osteoarthritis with a 10-year cumulative survival rate of 90.3% 28 . The Danish Shoulder Arthroplasty Registry reported 63 (7.5%) revisions in 837 resurfacing hemiarthroplasties with a 5 year cumulative revision rate of 12.1% 14 .…”