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. 2011 Nov;93(11):1513-7.
doi: 10.1302/0301-620X.93B11.26938.

Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008)

J A Singh  1 , J W Sperling, R H Cofield
Affiliations

Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008)

J A Singh et al. J Bone Joint Surg Br. 2011 Nov.

Abstract

Our objective was to examine the rate of revision and its predictive factors in patients undergoing total shoulder arthroplasty (TSA). We used prospectively collected data from the Mayo Clinic Total Joint Registry to examine five-, ten- and 20-year revision-free survival following TSA and the predictive factors. We examined patient characteristics (age, gender, body mass index, comorbidity), implant fixation (cemented versus uncemented), American Society of Anesthesiologists class and underlying diagnosis. Univariate and multivariable adjusted hazard rates were calculated using Cox regression analysis. A total of 2207 patients underwent 2588 TSAs. Their mean age was 65.0 years (19 to 91) and 1163 (53%) were women; osteoarthritis was the underlying diagnosis in 1640 shoulders (63%). In all, 212 TSAs (8.2%) were revised during the follow-up period. At five, ten and 20 years, survival rates were 94.2% (95% confidence interval (CI) 93.2 to 95.3), 90.2% (95% CI 88.7 to 91.7) and 81.4% (95% CI 78.4 to 84.5), respectively. In multivariable analyses men had a higher hazard ratio of revision of 1.72 (95% CI 1.28 to 2.31) (p < 0.01) compared with women, and those with rotator cuff disease had a hazard ratio of 4.71 (95% CI 2.09 to 10.59) (p < 0.001) compared with patients with rheumatoid arthritis. We concluded that male gender and rotator cuff disease are independent risk factors for revision after TSA. Future studies are needed to understand the biological rationale for these differences.

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Conflict of interest statement

Financial Conflict: There are no financial conflicts related directly to this study. J.A.S. has received speaker honoraria from Abbott; research and travel grants from Takeda, Savient, Wyeth and Amgen; and consultant fees from URL pharmaceuticals, Novartis and Savient. J.S. has received royalties from Aircast and Biomet, consultant fees from Tornier and owns stock in Tornier. R.C. has received royalties from Smith and Nephew.

This study was approved by the Mayo Clinic Institutional Review Board and all investigations were conducted in conformity with ethical principles of research.

Figures

Figure 1
Figure 1. Kaplan-Meir curves for unadjusted revision-free survival for the entire cohort (1a) and by gender (1b), age (1c) and underlying diagnosis (1d)
1a: The number of shoulders under observation after primary TSA were as follows, respectively: 5-years 1,437; 10-years, 810; 15-years, 365; and 20-years, 120. The cumulative number of revision surgeries at 5-, 10-, 15- and 20-years were post-TSA, 118, 165, 200 and 208, respectively. 1b: The figure shows the unadjusted revision-free survival by gender, which was significantly higher for women than men 1c: The figure shows the unadjusted revision-free survival by age, which was significantly higher for older patients 1d: The figure shows the unadjusted revision-free survival by diagnosis, which was significantly higher for diagnosis such as rotator cuff disease or tumor
Figure 1
Figure 1. Kaplan-Meir curves for unadjusted revision-free survival for the entire cohort (1a) and by gender (1b), age (1c) and underlying diagnosis (1d)
1a: The number of shoulders under observation after primary TSA were as follows, respectively: 5-years 1,437; 10-years, 810; 15-years, 365; and 20-years, 120. The cumulative number of revision surgeries at 5-, 10-, 15- and 20-years were post-TSA, 118, 165, 200 and 208, respectively. 1b: The figure shows the unadjusted revision-free survival by gender, which was significantly higher for women than men 1c: The figure shows the unadjusted revision-free survival by age, which was significantly higher for older patients 1d: The figure shows the unadjusted revision-free survival by diagnosis, which was significantly higher for diagnosis such as rotator cuff disease or tumor
Figure 1
Figure 1. Kaplan-Meir curves for unadjusted revision-free survival for the entire cohort (1a) and by gender (1b), age (1c) and underlying diagnosis (1d)
1a: The number of shoulders under observation after primary TSA were as follows, respectively: 5-years 1,437; 10-years, 810; 15-years, 365; and 20-years, 120. The cumulative number of revision surgeries at 5-, 10-, 15- and 20-years were post-TSA, 118, 165, 200 and 208, respectively. 1b: The figure shows the unadjusted revision-free survival by gender, which was significantly higher for women than men 1c: The figure shows the unadjusted revision-free survival by age, which was significantly higher for older patients 1d: The figure shows the unadjusted revision-free survival by diagnosis, which was significantly higher for diagnosis such as rotator cuff disease or tumor
Figure 1
Figure 1. Kaplan-Meir curves for unadjusted revision-free survival for the entire cohort (1a) and by gender (1b), age (1c) and underlying diagnosis (1d)
1a: The number of shoulders under observation after primary TSA were as follows, respectively: 5-years 1,437; 10-years, 810; 15-years, 365; and 20-years, 120. The cumulative number of revision surgeries at 5-, 10-, 15- and 20-years were post-TSA, 118, 165, 200 and 208, respectively. 1b: The figure shows the unadjusted revision-free survival by gender, which was significantly higher for women than men 1c: The figure shows the unadjusted revision-free survival by age, which was significantly higher for older patients 1d: The figure shows the unadjusted revision-free survival by diagnosis, which was significantly higher for diagnosis such as rotator cuff disease or tumor
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References

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