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Shoulder Fracture ArthroplastyShoulder Fracture Arthroplasty
Björn Salomonsson2009
Björn Salomonsson2009
Started 1999Started 1999
Swedish Shoulder Arthroplasty Register www.ssas.se/axel
Swedish Shoulder Arthroplasty Register www.ssas.se/axel
Started by SSASStarted by SSAS
5-year follow-up by WOOS-score. Pilot 1-year follow-up by WOOS-score
(and pre-op WOOS). 10-year follow-up by WOOS-score
(started 2009).
5-year follow-up by WOOS-score. Pilot 1-year follow-up by WOOS-score
(and pre-op WOOS). 10-year follow-up by WOOS-score
(started 2009).
20092009
>6400 reports of shoulder arthroplasty 7 % re-operations. WOOS score
>300 answers, 1 year (pilotstudy). >1400 answers, 5 year. (10 year starting 2009).
>6400 reports of shoulder arthroplasty 7 % re-operations. WOOS score
>300 answers, 1 year (pilotstudy). >1400 answers, 5 year. (10 year starting 2009).
10 years 1999-200810 years 1999-2008
1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder register 5 years after the surgery.
The surgery was performed 1999-2003 and the 5-year follow-up analysed was performed during 2004-2008.
1184 of the patients had a primary arthroplasty at the index operation.
1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder register 5 years after the surgery.
The surgery was performed 1999-2003 and the 5-year follow-up analysed was performed during 2004-2008.
1184 of the patients had a primary arthroplasty at the index operation.
Results: Fracture Arthroplasty at 5 years 1999-2003
Results: Fracture Arthroplasty at 5 years 1999-2003
Fractures: (median) WOOS % of healthy shoulder
Hemiarthroplasty (n = 380) WOOS 64%
< 2 weeks to surgery (n=315) WOOS 68% > 2 weeks to surgery (n=65) WOOS 61%
Malunion (n=34) WOOS 56% Non union (n=33) WOOS 43%
Fractures: (median) WOOS % of healthy shoulder
Hemiarthroplasty (n = 380) WOOS 64%
< 2 weeks to surgery (n=315) WOOS 68% > 2 weeks to surgery (n=65) WOOS 61%
Malunion (n=34) WOOS 56% Non union (n=33) WOOS 43%
Results: Fracture Arthroplasty at 5 years
Results: Fracture Arthroplasty at 5 years
It is better to offer early surgery by arthroplasty, compared to after 2 weeks or later, to the patient with a fracture regarding the outcome at the 5-year follow-up by WOOS score.
It is better to offer early surgery by arthroplasty, compared to after 2 weeks or later, to the patient with a fracture regarding the outcome at the 5-year follow-up by WOOS score.
Re-operation burden for fracture is low.
Re-operation burden for fracture is low.
Re-operation burden / Diagnose
6,5%
4,8%
4,4%
3,4%3,1%
2,1% 2,0%
1,5%
0,0%
1,0%
2,0%
3,0%
4,0%
5,0%
6,0%
7,0%
CuffArthropathy
Nonunion Ostenecrosis Reumatoid Osteoartrosis Fracture Malunion Other
But the failures are early?But the failures are early?Diagnose / Time to re-op (years)
1,2 1,2
1,8 1,8
2,42,6
4,7
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
Cuff Arthropathy Fracture Malunion Nonunion Ostenecrosis Osteoartrosis Reumatoid
Comparison to the Danish register 2007
Comparison to the Danish register 2007
Danish/Swedish Register (2007) Age distribution and (mean) age are very
similar Distribution of diagnosis are very similar Denmark do more surgery / 100 000
inhabitantsFracturesResurfacing in Osteoarthritis
Danish/Swedish Register (2007) Age distribution and (mean) age are very
similar Distribution of diagnosis are very similar Denmark do more surgery / 100 000
inhabitantsFracturesResurfacing in Osteoarthritis
Incidens in Sweden and DenmarkIncidens in Sweden and Denmark
All shoulders / 2007 All shoulders / 2007Fractures in 2007
2,7
31,60%
8,2
50,50%
0
1
2
3
4
5
6
7
8
9
Incidens / 100 000 inhabitants % in 2007
Sweden (n=247)
Denmark (n=441)
Fractures in Arthroplasty Register
2,2
35,20%
5,6
57,60%
0
1
2
3
4
5
6
Incidens / 100 000 inhabitants % in All
Sweden (n=1953)
Denmark (=1216)
Results from timing and volumeResults from timing and volume
WOOS 1 år (median) score, (aim 50%): SWE 5 y
Denmark <2 weeks n=359 57% 68%
< 20 /year 52% 20-<40 /year 56% =>40 /year 62%
Denmark >2 weeks n=162 46% 61%
WOOS 1 år (median) score, (aim 50%): SWE 5 y
Denmark <2 weeks n=359 57% 68%
< 20 /year 52% 20-<40 /year 56% =>40 /year 62%
Denmark >2 weeks n=162 46% 61%
Surgery timing Denmark/SwedenSurgery timing Denmark/SwedenFracture treatment timing
85,5%
14,5%
65,5%
33,5%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
< 2 weeks > 2 weeks
Sweden
Denmark
Fracture treatment timing
85,5%
14,5%
65,5%
33,5%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
< 2 weeks > 2 weeks
Sweden
Denmark
Result: 5 year (mean) WOOS % OA / RA
Result: 5 year (mean) WOOS % OA / RAElevctive diagnosis 5-year WOOS %
72
63 62
72
0
10
20
30
40
50
60
70
80
90
100
Primary Osteoarthrosis(n=289)
Sekundary Osteoarthrosis (n=72)
Reumatoid Arthritis (n=255)
Juvenil RA (n=10)
5-year WOOS %
Elevctive diagnosis 5-year WOOS %
72
63 62
72
0
10
20
30
40
50
60
70
80
90
100
Primary Osteoarthrosis(n=289)
Sekundary Osteoarthrosis (n=72)
Reumatoid Arthritis (n=255)
Juvenil RA (n=10)
5-year WOOS %
Result: 5 year WOOS % for FX diagnosis
Result: 5 year WOOS % for FX diagnosis
55%
59%
47%
53%
62%65%
60%
0%
10%
20%
30%
40%
50%
60%
70%
WOOS 5 year p=0,0002
CUFF ARTHROPATY & FRACTURE 5 YEAR MEAN WOOS
Cuffartropati (n=60)
Caputnekros (n=42)
Pseudartros (n=32)
Malunion (n=31)
Healed fx (n=7)
Fracture < 2w (n=314)
Fracture > 2w (n=62)
Result in WOOS % 5 years 1999-2003 Number of Fx / Hospital 1999-2008
Result in WOOS % 5 years 1999-2003 Number of Fx / Hospital 1999-2008
WOOS 5 year FX
8
1923
26 28 30 31 32 32 3437 37
42 42 4449
52 53
61
82 8389 92 93
111
124
134
149
164
58 5761
75 76
61
47
69
60 57
70
57
69
56
66
53
61
52 5457 60
85
5851
6764
58
7064
0
20
40
60
80
100
120
140
160
180
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Reported Fx
WOOS 5 år
The future?The future?
New or coming trends in treatment of proximal humeral fracturs: Locking plates? Increasing Arthroplasty? Increasing Early arthroplasty surgery?Better than late! Reversed shoulder arthroplasty?Even better?
New or coming trends in treatment of proximal humeral fracturs: Locking plates? Increasing Arthroplasty? Increasing Early arthroplasty surgery?Better than late! Reversed shoulder arthroplasty?Even better?
Proximal Humeral FractureProximal Humeral Fracture Classification?
Choice of treatment? Circulation?
Keep the humeral head? Later Caput necrosis?
Osteoporosis? Fixation? Bony healing?
Soft tissue quality? Rotator cuff balance? Muscle function?
Patient Outcome? Satisfaction? Function? Pain?
Classification? Choice of treatment?
Circulation? Keep the humeral head? Later Caput necrosis?
Osteoporosis? Fixation? Bony healing?
Soft tissue quality? Rotator cuff balance? Muscle function?
Patient Outcome? Satisfaction? Function? Pain?
Distribution in Sweden 2007-2008Distribution in Sweden 2007-2008Treatment of fractures 2007-2008
57
116
245
58106
6
147
346
749
178
350
37
204
462
994
236
456
43
0
200
400
600
800
1000
1200
Pins/Cerklage Intramedullary Plating Other IF Hemi Reversed
Men
Women
Total
Treatment of fractures 2007-2008
57
116
245
58106
6
147
346
749
178
350
37
204
462
994
236
456
43
0
200
400
600
800
1000
1200
Pins/Cerklage Intramedullary Plating Other IF Hemi Reversed
Men
Women
Total
Distribution by percentageDistribution by percentage% Fracture treatment 2007-2008
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
30,0%
35,0%
40,0%
45,0%
Pins/Cerklage Intramedullary Plating Other IF Hemi Reversed
Men
Women
Total
% Fracture treatment 2007-2008
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
30,0%
35,0%
40,0%
45,0%
Pins/Cerklage Intramedullary Plating Other IF Hemi Reversed
Men
Women
Total
Choice of treatmentChoice of treatment
Fracture surgery in Stockholm 2007-2008
Differences between Hospitals
Fracture surgery in Stockholm 2007-2008
Differences between Hospitals
Choice of treatment in StockholmChoice of treatment in Stockholm
4
42
24
4
38
1
8
22
106
11
105
27
8
25
10
33
54
14
10
36
12
5
119
3
25
19
11
631
0
20
40
60
80
100
120
140
160
180
Danderyd Huddinge Karolinska S:t Göran Södersjh OtherHospital
Treatment in Stockholm 2007-2008
Reversed
Hemiarthroplasty
Other IF
Plating
Intramedullry
Pins/Cerklage
4
42
24
4
38
1
8
22
106
11
105
27
8
25
10
33
54
14
10
36
12
5
119
3
25
19
11
631
0
20
40
60
80
100
120
140
160
180
Danderyd Huddinge Karolinska S:t Göran Södersjh OtherHospital
Treatment in Stockholm 2007-2008
Reversed
Hemiarthroplasty
Other IF
Plating
Intramedullry
Pins/Cerklage
Fracture arthroplasty in StockholmFracture arthroplasty in Stockholm
38
1
11
25
10
36
25
31
0
5
10
15
20
25
30
35
40
45
50
Danderyd Huddinge Karolinska S:t Göran Södersjh Other
Treatment shoulder arthroplasty Stockholm 2007-2008
Reversed
Hemiarthroplasty
Implants for fracture 1999-2008Implants for fracture 1999-2008Implants 1999-2008
211
23
163
347
44
70
41
23
86
256
228
84
32
0 50 100 150 200 250 300 350 400
3M modular
Tornier
Tornier fx
Bigliani
Biomodular
Comprehensive
Delta 3
Delta Xtend
Global
Global fx
Neer 2
Neer 3
Polarus Number
Implants for fracture 1999-2008Implants for fracture 1999-2008Implants 1999-2008
211
23
163
347
44
70
41
23
86
256
228
84
32
0 50 100 150 200 250 300 350 400
3M modular
Tornier
Tornier fx
Bigliani
Biomodular
Comprehensive
Delta 3
Delta Xtend
Global
Global fx
Neer 2
Neer 3
Polarus Number2000
2000
2002
20042005
WOOS 5 years for fx implants 1999-2003WOOS 5 years for fx implants 1999-2003Implats fx/ WOOS 5 years
84
53
21
42
34
74
58
65
70
65
61
64
0 10 20 30 40 50 60 70 80 90
3M modular
Bigliani
Biomodular
Global
Global fx
Neer 2
WOOS
Answers