Patients undergoing shoulder arthroplasty for failed nonoperative treatment of proximal humerus fracture have low implant survival and low patient-reported outcomes: 837 cases from the Danish Shoulder Arthroplasty Registry

Abstract

Background and purpose — When nonoperative treatment of proximal humerus fracture (PHF) fails, shoulder arthroplasty may be indicated. We investigated risk factors for revision and evaluated patient-reported outcome 1 year after treatment with either stemmed hemiarthroplasty (SHA) or reverse total shoulder arthroplasty (RTSA) after previous nonoperative treatment of PHF sequelae. Patients and methods — Data were derived from the Danish Shoulder Arthroplasty Registry and included 837 shoulder arthroplasties performed for PHF sequelae between 2006 and 2015. Type of arthroplasty, sex, age, and surgery period were investigated as risk factors. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome (0–100, 0 indicates worst outcome). Cox regression and linear regression models were used in the statistical analyses. Results — 644 patients undergoing SHA and 127 patients undergoing RTSA were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RTSA were revised. Men undergoing RTSA had a higher revision rate than men undergoing SHA (hazard ratio [HR] 6, 95% confidence interval [CI] 2–19). 454 (62%) patients returned a complete WOOS questionnaire. The mean WOOS score was 53 for SHA and 53 for RTSA. Patients who were 65 years or older had a better WOOS score than younger patients (mean difference 7, CI 1–12). Half of patients had WOOS scores below 50. Interpretation — Shoulder arthroplasty for PHF sequelae was associated with a high risk of revision and a poor patient-reported outcome. Men treated with RTSA had a high risk of revision.

Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial

“…However, the recent literature is inconclusive on gender driven differences in outcome. 28,46,47 Significant differences found by our study are in concordance with the literature. However, for both RSA and HA, some studies found superior objective outcomes compared with ours.…”

“…Patients with a previous osteosynthesis of the shoulder and/or a delay in presentation to the emergency department of more than 1 month were also excluded. 28,29 Patients with a glenoid bone defect greater than 30% or more than 15 degrees retroversion of the glenoid were excluded. Informed consent was obtained from all individual participants.…”

Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review

“… 95 Other time points consisted of fractional time points, for example, 2.5, 7.3, etc. 23-25 , 43 , 47 , 64 , 81 …”

Agreement between the American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment score (ASES) and the Oxford Shoulder Score (OSS) in patients presenting with shoulder pathology: A cohort analysis of the Clinical Quality Registry for Outcomes in Shoulder and Elbow Pathology (CROSEP) registry

“…Incomplete PROM data is a common issue that affects other regional and national registries, [38][39][40][41][42][43][44][45][46][47] reflecting the difficulty in obtaining complete patient data even when multilevel data collection systems are put in place. The finding that incomplete data was slightly more likely to be an issue in male patients with rotator cuff pathology may be of use in identifying patients that are "at risk" of incomplete data and directing more resources at them to ensure the data is correctly completed.…”