Assessment of the Value of Registries in Shoulder Arthroplasty Using Reverse Arthroplasty as an Example

Abstract

Introduction As a consequence of the Swedish model, endoprosthesis registers have become increasingly important worldwide. Due to the increasing number of joint replacements at the shoulder, these are being increasingly included in the register databases – in addition to interventions at the hip and knee joint. In this study, the value of endoprosthesis registers is investigated, using the example of shoulder endoprosthetics and including a comparison with clinical studies.

Material and Methods The annual reports of 32 different endoprosthesis registers with data on hip, knee and/or shoulder arthroplasty were analysed. The number of operations and demographic patient data for all areas of endoprosthetics were examined. In addition, a more detailed consideration of variables such as the primary diagnosis, the cause of the revision, the revision rate depending on risk factors and patient-reported outcome measures (PROM scores) was carried out exclusively for the shoulder joint endoprostheses. Using the example of the inverse shoulder prosthesis, clinical studies were compared to registry data with special regard to the revision rate.

Results A total of 20 endoprosthesis registers could be included, 9 of these collected data on shoulder arthroplasty. The main primary diagnoses were osteoarthritis (40.6%), rotator cuff defect arthropathy (30.2%) and fractures (17.6%). The most commonly used shoulder joint endoprosthesis was the inverse prosthesis (47.3%). The proportion of revision surgeries in total shoulder arthroplasty operations was less than 10% in all registers. In addition to the revision rate, the PROM scores were sometimes used in the registers to evaluate the success of the prosthesis. Compared to registry data, clinical studies showed more heterogeneous data with a significantly higher revision rate of over 10% in long-term follow-up – using the example of the inverse shoulder prosthesis.

Conclusion Register data are a valuable source of information in shoulder arthroplasty and can make a significant contribution to the quality assurance of endoprosthetic treatments. Compared to clinical studies, they primarily provide data on durability of different endoprosthesis and give lower revision rates. Clinical studies use PROM scores and clinical and radiological examinations to focus only on individual implants and surgical centres on the one hand and much more on the functional results on the other.

Keywords

endoprosthesis register - shoulder arthroplasty - endoprosthesis revision surgery

Publication History

Received: 03 May 2021

Accepted after revision: 08 September 2021

Article published online:
22 December 2021

• Literatur

• 1 de Steiger RN, Graves SE. Orthopaedic registries: the Australian experience. EFORT Open Rev 2019; 4: 409-415 DOI: 10.1302/2058-5241.4.180071. (PMID: 31210977)
• 2 Constant C, Murley A. A clinical method of functional assessment of the shoulder. Clin Orthop 1987; 3: 160-164 (PMID: 3791738)
• 3 Gorenoi V, Schönermark M, Hagen A. Gelenkendoprothesenregister für Deutschland. Köln: DIMDI; 2009. Im Internet (Stand: 11.04.2020): https://portal.dimdi.de/de/hta/hta_berichte/hta259_bericht_de.pdf
• 4 Magosch P, Habermeyer P, Lichtenberg S. et al. Ergebnisse des deutschen Schulter- und Ellenbogenprothesenregisters (SEPR). Orthopäde 2017; 46: 1063-1072 DOI: 10.1007/s00132-017-3485-4. (PMID: 29058027)
• 5 Malchau H, Garellick G, Berry D. et al. Arthroplasty implant registries over the past five decades: Development, current, and future impact. J Orthop Res 2018; 36: 2319-2330 DOI: 10.1002/jor.24014. (PMID: 29663575)
• 6 Robertsson O. Knee arthroplasty registers. J Bone Joint Surg Br 2007; 89: 1-4 DOI: 10.1302/0301-620X.89B1.18327. (PMID: 17259406)
• 7 Kolling C, Simmen B, Labek G. et al. Key factors for a successful National Arthroplasty Register. J Bone Joint Surg Br 2007; 89: 1567-1573 DOI: 10.1302/0301-620X.89B12.19409. (PMID: 18057354)
• 8 Zhu M, Ravi S, Frampton C. et al. New Zealand Joint Registry data underestimates the rate of prosthetic joint infection. Acta Orthop 2016; 87: 346-350 DOI: 10.3109/17453674.2016.1171639. (PMID: 27348450)
• 9 Swedish Knee Arthroplasty Register. Annual Report 2018. Im Internet (Stand: 21.10.2019): https://www.myknee.se/pdf/SVK_2018_Eng_1.0.pdf
• 10 Swedish Hip Arthroplasty Register. Annual Report 2017. 2017 Im Internet (Stand: 21.10.2019): https://registercentrum.blob.core.windows.net/refdocs/10.18158/BJxLUfemL4.pdf
• 11 National Joint Registry for England. 15th Annual Report 2018. 2018 Im Internet (Stand: 21.10.2019): https://www.hqip.org.uk/wp-content/uploads/2018/11/NJR-15th-Annual-Report-2018.pdf
• 12 Espehaug B, Furnes O, Havelin L. et al. Registration completeness in the Norwegian Arthroplasty Register. Acta Orthop 2006; 77: 49-56 DOI: 10.1080/17453670610045696. (PMID: 16534702)
• 13 New Zealand Orthopaedic Association (NZOA). The New Zealand Joint Registry, Nineteen Year Report January 1999 to December 2017. 2017 Im Internet (Stand: 21.10.2019): https://nzoa.org.nz/sites/default/files/DH8152_NZJR_2018_Report_v6_4Decv18.pdf
• 14 Dutch Arthroplasty Register (LROI). Online LROI annual report 2018. 2018 Im Internet (Stand: 21.10.2019): https://www.lroi-report.nl/app/uploads/2020/10/PDF-Online-LROI-annual-report-2018.docx-min.pdf
• 15 Werner BC, Burrus MT, Begho I. et al. Early revision within 1 year after shoulder arthroplasty: patient factors and etiology. J. Shoulder Elbow Surg 2015; 24: 323-330 DOI: 10.1016/j.jse.2015.05.035. (PMID: 26163282)
• 16 Wall B, Nové-Josserand L, O'Connor DP. et al. Reverse Total Shoulder Arthroplasty: A Review of Results According to Etiology. J Bone Joint Surg Am 2007; 89: 1476-1485 DOI: 10.2106/JBJS.F.00666. (PMID: 17606786)
• 17 Sirveaux F, Favard L, Oudet D. et al. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004; 86: 388-395
• 18 Samuelsen BT, Wagner ER, Houdek MT. et al. Primary reverse shoulder arthroplasty in patients aged 65 years or younger. J Shoulder Elbow Surg 2017; 26: e13-e17 DOI: 10.1016/j.jse.2016.05.026. (PMID: 27522342)
• 19 Frankle M, Siegal S, Pupello D. et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am 2005; 87: 1697-1705 DOI: 10.2106/JBJS.D.02813. (PMID: 16085607)
• 20 Favard L, Levigne C, Nerot C. et al. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time?. Clin Orthop 2011; 469: 2469-2475 DOI: 10.1007/s11999-011-1833-y. (PMID: 21384212)
• 21 Ernstbrunner L, Suter A, Catanzaro S. et al. Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Before the Age of 60 Years: Long-Term Results. J Bone Joint Surg Am 2017; 99: 1721-1729 DOI: 10.2106/JBJS.17.00095. (PMID: 29040126)
• 22 Cuff D, Pupello D, Virani N. et al. Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency. J Bone Joint Surg Am 2008; 90: 1244-1251 DOI: 10.2106/JBJS.G.00775. (PMID: 18519317)
• 23 Collin P, Hervé A, Walch G. et al. Mid-term results of reverse shoulder arthroplasty for glenohumeral osteoarthritis with posterior glenoid deficiency and humeral subluxation. J Shoulder Elbow Surg 2019; 28: 2023-2030 DOI: 10.1016/j.jse.2019.03.002. (PMID: 31405717)
• 24 Clark NJ, Samuelsen BT, Alentorn-Geli E. et al. Primary reverse shoulder arthroplasty in patients older than 80 years of age: survival and outcomes. Bone Joint J 2019; 101: 1520-1525 DOI: 10.1302/0301-620X.101B12.BJJ-2018-1571.R2. (PMID: 31787000)
• 25 Boileau P, Gonzalez JF, Chuinard C. et al. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg 2009; 18: 600-606 DOI: 10.1016/j.jse.2009.03.011. (PMID: 19481959)
• 26 Zumstein M, Pinedo M, Old J. et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg 2011; 20: 146-157 DOI: 10.1016/j.jse.2010.08.001. (PMID: 21134666)
• 27 Rasmussen J, Brorson S, Hallan G. et al. Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic Arthroplasty Register Association. J Shoulder Elbow Surg 2016; 25: 369-377 DOI: 10.1016/j.jse.2016.02.034. (PMID: 27107732)
• 28 Grimberg A, Jansson V, Liebs T, Melsheimer O, Steinbrück A. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2017. 2017 Im Internet (Stand: 12.07.2019): https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/EPRD-Jahresbericht_2017_Einzelseiten_Online-Version.pdf
• 29 Labek G, Schöffl H, Meglic M. New Medical Device Regulations ahead – What does that mean for Arthroplasty Registers?. Acta Orthop 2015; 86: 5-6 DOI: 10.3109/17453674.2014.1002185. (PMID: 25583172)
• 30 Labek G, Janda W, Agreiter M. et al. Organisation, data evaluation, interpretation and effect of arthroplasty register data on the outcome in terms of revision rate in total hip arthroplasty. Int Orthop 2011; 35: 157-163 DOI: 10.1007/s00264-010-1131-4. (PMID: 20922385)
• 31 Hostettler S, Hersperger M, Herren D. Medizinische Register: Wo liegt der Schlüssel zum Erfolg?. SAEZ 2012; 93: 1251-1255
• 32 Lübbeke A, Rees J, Barea C. et al. International variation in shoulder arthroplasty: Incidence, indication, type of procedure, and outcomes evaluation in 9 countries. Acta Orthop 2017; 88: 592-599 DOI: 10.1080/17453674.2017.1368884. (PMID: 28880117)