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

Danish fracture implants 2007Danish fracture implants 2007

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

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