Outcomes and complications following Shoulder replacements

1. Audit of 100 consecutive
Shoulder Arthroplasties
S Srinivasan, UL Fellow
Mr P Monga, Consultant.

2. Aim
• Audit of personal Series of the first 100 consecutive shoulder
Replacements
• Benchmarking Surgical Practice
• Good medical practice
• Patient Information

4. Methodology
• Single surgeon series
• 1st 100 consecutive shoulder arthroplasties
• NHS(n=87) & Private (n=13).
• Review of electronic case records including EPR,
Bluespier and PACS
• Missing Data- late 2011, 2012

5. Demographics
• Demographics
• M:F 31:69 (100 shoulders)
• Age Range 50-92 yrs
• Indications
• OA &CTA 71
• RA 2
• Trauma 7
• Other 20 (revision)

6. Comparison with NJR Data
Parameter 13th NJR Report Our Audit
Indication for primary 75%:13%:3.5% 71%:7%:2%
(OA+CTA : Trauma : RA/Inflamm)

7. Co-morbidities
• ASA Grade
• Grade 1 - 6
• Grade 2 - 46
• Grade 3 - 33
• Grade 4 - 0
• Not documented - 15

8. Type of Arthroplasty
7%
28%
45%
5%
15%HemiArthroplasty
Anatomical TSR
Reverse
Stage 1
Revision

9. Comparison with NJR Data
Parameter 13th NJR Report Our Audit
Anatomical:Reverse:Hemi 34:39:24 28:45:7
Primary: Revision 97:3 80:20

10. Trends- type of arthroplasty
1
2
3
1
2
4
8
14
6
15
9
15
0
1
2 2
0
2
7
6
0
4
8
12
16
2013 2014 2015 2016
Hemiarthroplasty
Anatomic replacement
Reverse replacement
1st stg revision
Revision of replacement
2013 2014 2015 2016

11. Reflection
• Proportion of revisions increasing
• Hemi arthroplasty low numbers

12. Growth
0
10
20
30
40
2013 2014 2015 Till Sep 2016
Further 49 next year

13. Hemiarthroplasty (n=7)
0
10
20
30
40
2013
2014
2015
2016
Hemiarthroplasty
Total

14. Complications

15. Reference
19262 TSA and RSA
Mean FU 40.3 months
122 studies
Complications of Shoulder Arthroplasty
Bohsali KI, Bois, A, Wirth M
JBJS Am 2017; 99(3): 256-269

16. TSA (Primaries)
0
1
2
3
4
5
Loosening Glenoid
wear
Instability RC tear PP fracture Neural
injury
Infection Haematoma Deltoid
Injury
VTE
Bohsali et al Personal data

17. RSA (Primaries)
0
1.25
2.5
3.75
5
6.25
Instability PP Fracture Infection Loosening Neural Injury Acromial /
spine #
Haematoma Deltoid injury RC tear VTE

18. Medical
• DVT post op 1
• Post op Stroke( Post op 1 week) 1
• Chest infection (post discharge) 1
• Intraop arrhythmia 1

19. Surgical (Primary+Revision)
• Periprosthetic fracture -3
(Humeral Rim fracture 1, Glenoid Rim Fracture 1, Humeral Fracture 1)
• Dislocations - 2
• Acromial Stress Fracture - 1

20. Summary
• Steady increase in numbers and complexity
(revisions)
• Reverse Polarity > Anatomic
• Resurfacing arthroplasty unreliable outcome
• Complications Rates Lower than Literature controls

21. Summary
• Limitations
• Patients with Complications such as DVT may
have presented to a different hospital
• Assessment of glenoid wear and loosening
challenging in non standardised X-rays