1. The Swedish Shoulder Arthroplasty Register: 5-year follow up by WOOS shows better result from Total Shoulder replacement B Salomonsson, H Rahme, A Nordqvist B Salomonsson, H Rahme, A Nordqvist

2. The Swedish Shoulder Arthroplasty Register: Started 1999

3. Purpose  To analyse the answers from the patients that returned the 5-year follow- up by WOOS score from the Swedish Shoulder Arthroplasty Register during 2004 to 2008.  We also analysed the outcome of glenoid-problems as a cause to revision surgery.  To analyse the answers from the patients that returned the 5-year follow- up by WOOS score from the Swedish Shoulder Arthroplasty Register during 2004 to 2008.  We also analysed the outcome of glenoid-problems as a cause to revision surgery.

4. Purpose  We wanted to analyse the results by diagnoses concerning the different concepts of arthroplasty (elective Hemi or Total).  We also compared the outcome for the patients with fractures regarding the timing of the surgery (Hemi).  We wanted to analyse the results by diagnoses concerning the different concepts of arthroplasty (elective Hemi or Total).  We also compared the outcome for the patients with fractures regarding the timing of the surgery (Hemi).

5. Material and Methods  1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder registry 5 years after the surgery.  The surgery was performed 1999-2003 and the follow-up analysed was performed during 2004-2008.  1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder registry 5 years after the surgery.  The surgery was performed 1999-2003 and the follow-up analysed was performed during 2004-2008.

6. Material and Methods  1184 of the patients had a primary arthroplasty at the index operation.  All patients were evaluated by the WOOS score sent by mail.  1184 of the patients had a primary arthroplasty at the index operation.  All patients were evaluated by the WOOS score sent by mail.

7. Material and Methods  Total register > 6000 reports since 1999  8 % of the reports were re-operations.  2008: 925 reports (covers >93%)  WOOS score since 2004:  >200 answers, 1-year (pilotstudy).  >1200 answers, 5-year  10 -year started 2009.  Total register > 6000 reports since 1999  8 % of the reports were re-operations.  2008: 925 reports (covers >93%)  WOOS score since 2004:  >200 answers, 1-year (pilotstudy).  >1200 answers, 5-year  10 -year started 2009.

8. Results  Of the 2387 reports 1999-2003 in the register 1267 had answered by a complete score for follow-up at 5 year.  53% answered.  20% was dead or had a lost address.  27% did not answer.  The WOOS score results from 1184 primary procedures was analysed.  Of the 2387 reports 1999-2003 in the register 1267 had answered by a complete score for follow-up at 5 year.  53% answered.  20% was dead or had a lost address.  27% did not answer.  The WOOS score results from 1184 primary procedures was analysed.

9. Results RA  Reumatoid arthritis  HSA (n = 187) had WOOS 61%  TSA (n = 37) had WOOS 70%  Bipolar HSA (n = 15) had 57%.  p<0,05 between TSA and HSA  Reumatoid arthritis  HSA (n = 187) had WOOS 61%  TSA (n = 37) had WOOS 70%  Bipolar HSA (n = 15) had 57%.  p<0,05 between TSA and HSA

10. Results OA  Osteoartrosis  HSA (n = 180) had WOOS 68%  TSA (n = 92) had WOOS 83%,  Resurfacing HSA (n = 18) WOOS 67%  p<0,001 between TSA and HSA  Osteoartrosis  HSA (n = 180) had WOOS 68%  TSA (n = 92) had WOOS 83%,  Resurfacing HSA (n = 18) WOOS 67%  p<0,001 between TSA and HSA

11. Results Fx  Fractures  HSA (n = 380) had 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  HSA (n = 380) had 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%

12. Results 1-year  In our 1-year follow-up with pre- operative WOOS for baseline comparison, we find the same trend even though the numbers are still small.  RA and OA:  Hemi (n=110)preopWOOS 37%  postop WOOS 83%  Total (n=67)preopWOOS 40%  postopWOOS 91%  In our 1-year follow-up with pre- operative WOOS for baseline comparison, we find the same trend even though the numbers are still small.  RA and OA:  Hemi (n=110)preopWOOS 37%  postop WOOS 83%  Total (n=67)preopWOOS 40%  postopWOOS 91%

13. Revisions  Among 400 reported re-operations, we had the index-operation in the register for 125 shoulders. Of theese  53 shoulders OA  22 from 1999-2003  34 shoulders RA  26 from 1999-2003  Among 400 reported re-operations, we had the index-operation in the register for 125 shoulders. Of theese  53 shoulders OA  22 from 1999-2003  34 shoulders RA  26 from 1999-2003

14. Revisions until 2008  OA 1999-2003  HSA 20 revisions / 393 shoulders5%  Glenoid erosion 12 / 20 60%  TSA 2 revisions / 176 shoulders 1%  Glenoid problems 0  OA 1999-2003  HSA 20 revisions / 393 shoulders5%  Glenoid erosion 12 / 20 60%  TSA 2 revisions / 176 shoulders 1%  Glenoid problems 0

15. Revisions until 2008  RA 1999-2003  HSA 21 revisions / 337 shoulders6%  Glenoid erosion 8 / 2138%  TSA 2 revisions / 54 shoulders4%  Glenoid component 2 / 2100%  Bipolar: 3 revisions / 39 shoulders8%  Glenoid problems 0  RA 1999-2003  HSA 21 revisions / 337 shoulders6%  Glenoid erosion 8 / 2138%  TSA 2 revisions / 54 shoulders4%  Glenoid component 2 / 2100%  Bipolar: 3 revisions / 39 shoulders8%  Glenoid problems 0

16. Discussion  If possible it is better to offer a TSA than a HSA to the patient with Reumatoid arthritis or Osteoarthritis, regarding the outcome at the 5-year follow-up by WOOS score.

17. Discussion  It is better to offer early surgery by arthroplasty, compared to after 2 weeks, to the patient with a fracture regarding the outcome at the 5-year follow-up by WOOS score.

18. Conclusion  In the main diagnostic groups AO and RA Total Shoulder Arthroplasty (TSA) do better than the Hemi Shoulder Arthroplasty (HSA) in 5-year follow-up.

19. THANK YOU!

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