Shoulder%20Fracture%20Arthroplasty

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Shoulder Fracture Arthroplasty

• Björn Salomonsson
• 2009

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Started 1999

• Swedish Shoulder Arthroplasty Register
• www.ssas.se/axel

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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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2009

• gt6400 reports of shoulder arthroplasty
• 7 re-operations.
• WOOS score
• gt300 answers, 1 year (pilotstudy).
• gt1400 answers, 5 year.
• (10 year starting 2009).

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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.

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Results Fracture Arthroplasty at 5 years
1999-2003

• Fractures (median) WOOS of healthy shoulder
• Hemiarthroplasty (n 380) WOOS 64
• lt 2 weeks to surgery (n315) WOOS 68
• gt 2 weeks to surgery (n65) WOOS 61
• Malunion (n34) WOOS 56
• Non union (n33) WOOS 43

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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.

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Re-operation burden for fracture is low.
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But the failures are early?
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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

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Incidens in Sweden and Denmark

• All shoulders / 2007

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Results from timing and volume

• WOOS 1 år (median) score, (aim 50) SWE 5 y
• Denmark lt2 weeks n359 57 68
• lt 20 /year 52
• 20-lt40 /year 56
• gt40 /year 62
• Denmark gt2 weeks n162 46 61

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Surgery timing Denmark/Sweden
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Result 5 year (mean) WOOS OA / RA
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Result 5 year WOOS for FX diagnosis
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Result in WOOS 5 years 1999-2003 Number of Fx
/ Hospital 1999-2008
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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?

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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?

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Distribution in Sweden 2007-2008
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Distribution by percentage
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Choice of treatment

• Fracture surgery in Stockholm 2007-2008
• Differences between Hospitals

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Choice of treatment in Stockholm
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Fracture arthroplasty in Stockholm
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Implants for fracture 1999-2008
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Implants for fracture 1999-2008

• 2000

2000
2005
2004
2002
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Danish fracture implants 2007
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WOOS 5 years for fx implants 1999-2003
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Thank You!