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Shoulder Fracture Arthroplasty

Shoulder Fracture Arthroplasty. Björn Salomonsson 2009. Started 1999. Swedish Shoulder Arthroplasty Register www.ssas.se/axel. Started 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).

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Shoulder Fracture Arthroplasty

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  1. Shoulder Fracture Arthroplasty Björn Salomonsson 2009

  2. Started 1999 • Swedish Shoulder Arthroplasty Register • www.ssas.se/axel

  3. Started 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).

  4. 2009 • >6400 reports of shoulder arthroplasty • 7 % re-operations. • WOOS score • >300 answers, 1 year (pilotstudy). • >1400 answers, 5 year. • (10 year starting 2009).

  5. 10 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.

  6. 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%

  7. 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.

  8. Re-operation burden for fracture is low.

  9. But the failures are early?

  10. 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 inhabitants • Fractures • Resurfacing in Osteoarthritis

  11. Incidens in Sweden and Denmark • All shoulders / 2007

  12. Results 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%

  13. Surgery timing Denmark/Sweden

  14. Result: 5 year (mean) WOOS % OA / RA

  15. Result: 5 year WOOS % for FX diagnosis

  16. Result in WOOS % 5 years 1999-2003 Number of Fx / Hospital 1999-2008

  17. 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?

  18. Proximal 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?

  19. Distribution in Sweden 2007-2008

  20. Distribution by percentage

  21. Choice of treatment • Fracture surgery in Stockholm 2007-2008 • Differences between Hospitals

  22. Choice of treatment in Stockholm

  23. Fracture arthroplasty in Stockholm

  24. Implants for fracture 1999-2008

  25. Implants for fracture 1999-2008 2000 2000 2005 2004 2002

  26. Danish fracture implants 2007

  27. WOOS 5 years for fx implants 1999-2003

  28. Thank You!

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