Utilisation of shoulder arthroplasty in the UK

Ravenscroft, Matt; Calvert, P

doi:10.1308/003588404772614641

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…In our study, there were 84% hemiprostheses, which is similar to the findings from the Scottish and Swedish registries (88% and 87%, respectively) (Rahme et al 2001, Sharma andDreghorn 2006). Ravenscroft and Calvert (2004) reported twice as many HPs as TSRs in the UK, but there were more TSRs in a large American study (Jain et al 2004). …”

Section: Discussionsupporting

confidence: 90%

Risk factors for revision after shoulder arthroplasty

et al. 2009

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Background and purpose Previous studies on shoulder arthroplasty have usually described small patient populations, and few articles have addressed the survival of shoulder implants. We describe the results of shoulder replacement in the Norwegian population (of 4.7 million) during a 12-year period. Trends in the use of shoulder arthroplasty during the study period were also investigated.Patients and methods 1,531 hemiprostheses (HPs), 69 total shoulder replacements (Neer type TSR), and 225 reversed total shoulder replacement (reversed TSR) operations were reported to the Norwegian Arthroplasty Register between 1994 and 2005. Kaplan-Meier failure curves were drawn up for particular subgroups of patients, and revision rates were calculated using Cox regression analysis.Results The 5- and 10-year failure rates of hemiprostheses were 6% (95% CI: 5–7) and 8% (95% CI: 6–10), and for reversed total shoulder replacements they were 10% (95% CI: 5–15) and 22% (95% CI: 10–33), respectively. For hemiprostheses, the risk of revision for patients who were 70 years or older was half that of those who were younger (RR = 0.47, CI: 0.28–0.77), while the risk of revision was highest for patients with sequelae after fracture compared to those with acute fractures (RR = 3.3, CI: 1.5–7.2). No differences in prosthesis survival were found between the different hemiprosthesis brands. The main reasons for revision of hemiprostheses were pain and luxation. For reversed total prostheses, the risk of revision was less for women than for men (RR = 0.26, CI: 0.11–0.63), and the main cause of revision was aseptic loosening of the glenoid component. During the study period, the incidence of shoulder arthroplasty increased for all diagnostic groups except inflammatory arthritis, for which a decrease was seen.Interpretation We found good results in terms of 5-year prosthesis failure rate, with the use of hemiarthroplasty for patients with inflammatory arthritis, osteoarthritis, and acute fractures. Reversed total shoulder replacement was associated with a rather poor prognosis.

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Section: Discussionsupporting

confidence: 90%

Risk factors for revision after shoulder arthroplasty

et al. 2009

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“…14 Each year approximately 2500 are performed in the United Kingdom, which equates to a rate of 1.1 arthroplasties per 100 000 of the population per year; in the United States this rate is 11.4 per 100 000. [14][15][16] This has resulted in an increase in peri-prosthetic humeral fractures. 7 Most occur intra-operatively and heal, but there is a high incidence of associated nerve injury and fracture displacement.…”

Section: Discussionmentioning

confidence: 99%

Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement

Sewell

Kang

Al-Hadithy

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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There is little information about the management of peri-prosthetic fracture of the humerus after total shoulder replacement (TSR). This is a retrospective review of 22 patients who underwent a revision of their original shoulder replacement for peri-prosthetic fracture of the humerus with bone loss and/or loose components. There were 20 women and two men with a mean age of 75 years (61 to 90) and a mean follow-up 42 months (12 to 91): 16 of these had undergone a previous revision TSR. Of the 22 patients, 12 were treated with a long-stemmed humeral component that bypassed the fracture. All their fractures united after a mean of 27 weeks (13 to 94). Eight patients underwent resection of the proximal humerus with endoprosthetic replacement to the level of the fracture. Two patients were managed with a clam-shell prosthesis that retained the original components. The mean Oxford shoulder score (OSS) of the original TSRs before peri-prosthetic fracture was 33 (14 to 48). The mean OSS after revision for fracture was 25 (9 to 31). Kaplan-Meier survival using re-intervention for any reason as the endpoint was 91% (95% confidence interval (CI) 68 to 98) and 60% (95% CI 30 to 80) at one and five years, respectively. There were two revisions for dislocation of the humeral head, one open reduction for modular humeral component dissociation, one internal fixation for nonunion, one trimming of a prominent screw and one re-cementation for aseptic loosening complicated by infection, ultimately requiring excision arthroplasty. Two patients sustained nerve palsies. Revision TSR after a peri-prosthetic humeral fracture associated with bone loss and/or loose components is a salvage procedure that can provide a stable platform for elbow and hand function. Good rates of union can be achieved using a stem that bypasses the fracture. There is a high rate of complications and function is not as good as with the original replacement.

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“…In the UK, the provision of TSA and hemiarthroplasty is approximately one-tenth and one-fifth, respectively, per capita compared to the USA, 3 where the number of shoulder arthroplasties, particularly TSA, is growing rapidly. 4 Currently, 47, 000 shoulder replacements are performed annually in North America, of which approximately 27, 000 are TSA.…”

Section: Introductionmentioning

confidence: 99%