Shoulder Fracture Arthroplasty Björn Salomonsson 2009 Björn Salomonsson 2009

Started 1999  Swedish Shoulder Arthroplasty Register   Swedish Shoulder Arthroplasty Register 

Started by SSAS  5-year follow-up by WOOS-score.  Pilot 1-year follow-up by WOOS-score (and pre-op WOOS).  10-year follow-up by WOOS-score (started 2009).  5-year follow-up by WOOS-score.  Pilot 1-year follow-up by WOOS-score (and pre-op WOOS).  10-year follow-up by WOOS-score (started 2009).

2009  >6400 reports of shoulder arthroplasty  7 % re-operations.  WOOS score  >300 answers, 1 year (pilotstudy).  >1400 answers, 5 year.  (10 year starting 2009).  >6400 reports of shoulder arthroplasty  7 % re-operations.  WOOS score  >300 answers, 1 year (pilotstudy).  >1400 answers, 5 year.  (10 year starting 2009).

10 years  1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder register 5 years after the surgery.  The surgery was performed and the 5-year follow-up analysed was performed during  1184 of the patients had a primary arthroplasty at the index operation.  1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder register 5 years after the surgery.  The surgery was performed and the 5-year follow-up analysed was performed during  1184 of the patients had a primary arthroplasty at the index operation.

Results: Fracture Arthroplasty at 5 years  Fractures: (median) WOOS % of healthy shoulder  Hemiarthroplasty (n = 380)WOOS 64%  < 2 weeks to surgery (n=315) WOOS 68%  > 2 weeks to surgery (n=65) WOOS 61%  Malunion (n=34)WOOS 56%  Non union (n=33)WOOS 43%  Fractures: (median) WOOS % of healthy shoulder  Hemiarthroplasty (n = 380)WOOS 64%  < 2 weeks to surgery (n=315) WOOS 68%  > 2 weeks to surgery (n=65) WOOS 61%  Malunion (n=34)WOOS 56%  Non union (n=33)WOOS 43%

Results: Fracture Arthroplasty at 5 years It is better to offer early surgery by arthroplasty, compared to after 2 weeks or later, to the patient with a fracture regarding the outcome at the 5-year follow-up by WOOS score.

Re-operation burden for fracture is low.

But the failures are early?

Comparison to the Danish register 2007  Danish/Swedish Register (2007)  Age distribution and (mean) age are very similar  Distribution of diagnosis are very similar  Denmark do more surgery / inhabitants  Fractures  Resurfacing in Osteoarthritis  Danish/Swedish Register (2007)  Age distribution and (mean) age are very similar  Distribution of diagnosis are very similar  Denmark do more surgery / inhabitants  Fractures  Resurfacing in Osteoarthritis

Incidens in Sweden and Denmark  All shoulders / 2007

Results from timing and volume  WOOS 1 år (median) score, (aim 50%):SWE 5 y  Denmark <2 weeksn=359 57%68%  < 20 /year52%  20-<40 /year 56%  =>40 /year 62%  Denmark >2 weeks n=162 46%61%  WOOS 1 år (median) score, (aim 50%):SWE 5 y  Denmark <2 weeksn=359 57%68%  < 20 /year52%  20-<40 /year 56%  =>40 /year 62%  Denmark >2 weeks n=162 46%61%

Surgery timing Denmark/Sweden

Result: 5 year (mean) WOOS % OA / RA

Result: 5 year WOOS % for FX diagnosis

Result in WOOS % 5 years Number of Fx / Hospital

The future?  New or coming trends in treatment of proximal humeral fracturs:  Locking plates?Increasing  Arthroplasty?Increasing  Early arthroplasty surgery?Better than late!  Reversed shoulder arthroplasty?Even better?  New or coming trends in treatment of proximal humeral fracturs:  Locking plates?Increasing  Arthroplasty?Increasing  Early arthroplasty surgery?Better than late!  Reversed shoulder arthroplasty?Even better?

Proximal Humeral Fracture  Classification?  Choice of treatment?  Circulation?  Keep the humeral head?  Later Caput necrosis?  Osteoporosis?  Fixation?  Bony healing?  Soft tissue quality?  Rotator cuff balance?  Muscle function?  Patient Outcome?  Satisfaction?  Function?  Pain?  Classification?  Choice of treatment?  Circulation?  Keep the humeral head?  Later Caput necrosis?  Osteoporosis?  Fixation?  Bony healing?  Soft tissue quality?  Rotator cuff balance?  Muscle function?  Patient Outcome?  Satisfaction?  Function?  Pain?

Distribution in Sweden

Distribution by percentage

Choice of treatment  Fracture surgery in Stockholm  Differences between Hospitals  Fracture surgery in Stockholm  Differences between Hospitals

Choice of treatment in Stockholm

Fracture arthroplasty in Stockholm

Implants for fracture

Danish fracture implants 2007

WOOS 5 years for fx implants

Thank You!