Lower age increases the risk of revision for stemmed and resurfacing shoulder hemi arthroplasty

Abstract

Background and purpose - The number of patients where shoulder hemiarthroplasty (SHA) is an option is still substantial. Descriptive analyses performed by the Swedish Shoulder Arthroplasty Registry (SSAR) showed that while patients receiving SHA designs, i.e. resurfacing hemi (RH) and stemmed hemi (SH), reported similar shoulder functionality and quality of life, the revision rate for RH (12%) was larger than for SH (6.7%); this difference was studied. Patients and methods - All primary SHA (n = 1,140) for OA reported to SSAR between 1999 and 2009 were analyzed regarding risk factors for revision and PROM outcome, 950 shoulders with primary OA (POA), and 190 secondary OA (SOA). Mean age was 67.4 years (SD 10.8). PROM including WOOS and EQ-5D were collected at 5 years, until December 31, 2014. Results - 76/950 prostheses because of POA and 16/190 prosthesis because of SOA were revised. Age at primary surgery was the main factor that influenced the risk of revision, lower age increased the risk of revision, and was also the explanation for the difference between SH and RH. We also found that SH and RH had similar outcomes measured by PROM, but the POA group had higher scores than the SOA group with a clinically relevant difference of 10% in WOOS. Interpretation - The risk of revision for SH and RH is similar when adjusted for age and does not depend on primary diagnosis or sex. A lower age increases the risk of revision. Patients suffering from POA experience better shoulder functionality than SOA patients irrespective of implant type.

Figure 1.

Proportion of different implant types for treatment of OA reported to the Swedish Shoulder Arthroplasty Register during the period 1999–2015. “OA stemmed total” includes only anatomical implants. OA = osteoarthritis.

Figure 2.

Data included in the study. POA = primary osteoarthritis, SOA = secondary osteoarthritis, HA = hemiarthroplasty.

Figure 3.

Time to revision for shoulder hemiarthroplasty for primary and secondary osteoarthritis 1999–2009.

Figure 4.

Survival curves for different median ages and results from the Cox model. Only age has a significant effect for revision (no statistically significant effect from diagnoses, implant and sex). Age at primary operation: Hazard ratio =0.94 (CI 0.93–0.96) p < 0.001.