Registries | SECEC-ESSSE

Implant registries

The first shoulder implant registry started in Finland in 1980, Norway followed in 1994 and nowadays a shoulder registry exists in the United Kingdom, Denmark, Norway, Sweden, Finland, the Netherlands, New Zealand, Australia, Germany, Portugal, and the Kaiser Permanente in California. Registries were set up to detect poor prosthetic designs at an early stage and to provide for the track and traceability of these prostheses. Currently registries are used for implant surveillance, and to assess incidence, indication, type of procedure and revision. The available data can help to estimate the future economic impact on our health care systems, and they can also be used to provide information to benchmark shoulder arthroplasty for ODEP.

Existing registries report on surgeon-derived measures, as key-outcome is revision, but there is an increasing demand of all stakeholders for more patient focused outcome measurements. Ideally registries should relate to patient derived outcome measurements as PROMs to enable us to analyze clinical outcome. In several countries the PROMs are already linked to the registry.

Long-term follow-up is required to exhibit differences in outcome and problems with procedures and implants leading to revision surgery. From what is known from existing national registries, there are large variations in indications and type of surgery. Comparative analysis of national registries is difficult as there is a difference in the parameters and outcome measurements recorded. Merging data from different national registries into a common database would enable us to compare incidence, indication, procedure, but also results, and the higher number of cases in such a database would improve the statistical strength of studies. However, this can only be obtained if we agree to use a similar set of variables and outcome measurements.

Role of the SECEC registry committee

The two main goals of the committee are:

to advocate the usefulness and importance of national arthroplasty registries to members of the SECEC. If we manage to improve the completeness of the registries this can lead to studies to discover differences between techniques and designs. This will encourage surgeons to use this instrument because it permits to measure and improve the quality of medical care.
to support collaboration between registries and make recommendations on how to combine existing Shoulder and Elbow registry data in Europe to better inform surgical practice and improve outcomes. Based on the minimum data sets recorded in each existing registry, we have produced a SECEC “minimum data set” that other European countries can consider using if they decide to set up a shoulder or elbow joint replacement registry. This includes patient-related data (age, gender, and diagnosis), operative data (date, arthroplasty type), and data for cases of revision (date, reason for revision, and new arthroplasty type). The SECEC Registry Committee members can offer their assistance to any new emerging registries to share their knowledge.

Incentive of the SECEC registry committee

Since 2020 a SECEC registry committee has joined and efforts are undertaken to set-up a collaboration to build a European shoulder registry. If this initiative is supported by the national orthopedic associations, it can gradually gain popularity which can translate into the willingness to use compatible data on a national scale. The SECEC registry committee is working on the organization of a European rotator cuff collaboration. A Delphi approach is used to determine what variables future rotator cuff registries should include.

Current members are Rui Claro, Eoghan Hurley, Anne Karelse, Petra Magosh, Oliver Schoierer and Jeppe Rasmussen.

Recomended publications on registry data within the last 3 years

Shoulder

2023

The Delta III and Delta Xtend reverse shoulder arthroplasty. Risk of revision and failure mechanisms: a report on 3,650 cases from the Norwegian Arthroplasty Register 1994-2021. Randi M. Hole, Anne Marie Fenstad, Jan-Erik Gjertsen, Geir Hallan,Ove N. Furnes. Journal of Shoulder and Elbow: August 11, 2023 Discussion: We found that Delta III (uncemented stem) had higher risk of revision compared to Delta Xtend (cemented stem). The risk of revision for glenoid component loosening was lower for Delta Xtend, but revisions due to instability/dislocation is still a concern. This register study cannot determine whether the differences found were caused by differences in implant design or other factors that changed during the study period. Risk of revision may have been affected by the indication for primary operation.

Survivorship of shoulder arthroplasty in young patients with osteoarthritis: an analysis of the Australian Orthopaedic Association National Joint Replacement Registry. Al-achraf Khoriati, Andrew P. McBride, Mark Ross, Phil Duke, Greg Hoy, Richard Page and others. Journal of Shoulder and Elbow May 10, 2023. Conclusion: These results should be interpreted within the context of the lack of availability of long-term data on RTSA and HSPH stems. RTSA outperforms all implants regarding revision rates at mid-term follow-up. The high early dislocation rate associated with RTSA, as well as the lack of revision options available to address this, indicates that careful selection of patients and a greater appreciation of anatomic risk factors are needed in the future.

Primary reverse total shoulder arthroplasty for fractures requires more revisions than for degenerative conditions one year after surgery: an analysis from the Dutch Arthroplasty Register. . Reinier W.A. Spek, Anneke Spekenbrink-Spooren, Joost W. Vanhommerig, Nini Jonkman, Job N. Doornberg, Ruurd L. Jaarsma and others. Journal of Shoulder and Elbow Surgery: June 14, 2023. Conclusion: Patients undergoing primary RTSA for fractures have a substantially higher likelihood of undergoing revision within the first year following the procedure than patients with degenerative conditions preoperatively. Although RTSA is regarded as a reliable and safe treatment option for fractures, surgeons should inform patients accordingly and incorporate this information in decision making when opting for head replacement surgery. There were no differences in patient-reported outcomes between the 2 groups and no differences in revision rates between conventional and fracture-specific stem designs.

MEDIUM-TERM RESULTS OF INLAY VERSUS ONLAY HUMERAL COMPONENTS FOR REVERSE SHOULDER ARTHROPLASTY: A NEW ZEALAND JOINT REGISTRY STUDY. Yushy Zhou, Avanthi Mandaleson, Chris Frampton, Marc Hirner. Journal of Shoulder and Elbow Surgery: July 7, 2023 Conclusion: The medium-term survival of in-RSA was higher than that of on-RSA. However, functional outcomes at 6 months were better for on-RSA compared to in-RSA. Further follow-up is required to understand the long-term survivorship and functional outcomes between these designs.

The lifetime revision risk of primary anatomic and reverse total shoulder arthroplasty. Zhou Y, Mandaleson A, Frampton C, Hirner M. J Shoulder Elbow Surg. 2023 May 11 Conclusions: Our study demonstrates that younger patients have higher lifetime revision risk after total shoulder arthroplasty. Our results highlight the long-term revision risks associated with the trend of offering shoulder arthroplasty to younger patients. The data may be used among various health care stakeholders to inform the surgical decision-making process and plan for future health care resource use.

A comparison of revision rates for stemmed and stemless primary anatomic shoulder arthroplasty with all polyethylene glenoid components. Analysis from the Australian Orthopaedic Association National Joint Replacement Registry. David R.J. Gill, Sophia Corfield, Dylan Harries, Richard S. Page. Journal of Shoulder and Elbow Surgery July 24, 2023. Conclusion: Revision rates of stTSA and slTSA did not significantly differ and were associated with humeral head size but not patient characteristics. Surgeon inexperience of anatomic shoulder arthroplasty and non XLPE glenoids were risk factors for stTSA revision, but not slTSA. Metal/XLPE stTSA rate of revision was not found to differ significantly from slTSA regardless of polyethylene or humeral head bearing type. Revision for instability/dislocation was more common for slTSA.

Short-term outcomes following 159 stemmed pyrolytic carbon shoulder hemiarthroplasties and how they compare with conventional hemiarthroplasties and total shoulder arthroplasties in patients younger than 60 years with osteoarthritis: results from the New Zealand National Joint Registry. Gao R, Viswanath A, Frampton CM, Poon PC. J Shoulder Elbow Surg. 2023 Aug;32(8):1594-1600. Conclusions: This study represents the largest cohort of patients treated with PyCHA and is the first to compare stemmed PyCHA with HA and aTSA in young patients. In the short term, PyCHA appear to be a promising implant with an excellent implant retention rate. In patients aged <60 years, the revision rate is comparable between PyCHA and aTSA. However, aTSA remains the implant of choice to optimize early postoperative function. Further studies are required to elucidate the long-term outcomes of PyCHA, particularly how they compare with those of HA and aTSA in young patients .

Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty. Marie L. Jensen, Steen L. Jensen, Matthijs Bolder, Klaus W.J. Hanisch, Anne Kathrine B. Sørensen, Bo S. Olsen, Thomas FalstieJensen, Jeppe V. Rasmussen. J Shoulder Elbow Surg (2023) 32, 111–120. Conclusion: There is an increased risk of revision owing to PJI after RSA for patients with previous rotator cuff repair. We recommend that patients with previous rotator cuff repair be regarded as highrisk patients when considering RSA.

The reliability of revision rates following primary shoulder arthroplasty as a quality indicator to rank hospital performance: a national registry analysis including 13,104 shoulders and 87 hospitals. Lotje A. Hoogervorst, Peter van Schie, Jochem Nagels, Rob G.H.H. Nelissen, MD, Perla J. Marang-van de Mheen. J Shoulder Elbow Surg (2023) 32, 59–67. Conclusion: Considerable between-hospital variation was observed for 1- and 3-year revision rates following primary SA, where outlier hospitals could be identified based on large differences in revision for specific indications to direct quality improvement initiatives.