1. Trends – what do the registries tell us? Swedish registry example Anders Nordqvist MD, PhD, Associate professor Skane University Hospital Malmö Sweden

2. The swedish shoulder arthroplasty registry Property of the Swedish shoulder and elbow society Started in 1999 Administrated by Björn Salomonsson, MD, PhD, Danderyd Hospital, Stockholm, Sweden Board appointed by the Swedish shoulder and elbow society : Hans Rahme, MD, PhD, Uppsala Sweden Anders Nordqvist, MD PhD, Malmö Sweden Henrik Ahlborg, MD, PhD, Malmö, Sweden Anders Ekelund, MD, PhD, Stockholm, Sweden Björn Salomonsson, MD, PhD, Stockholm, Sweden

3. The swedish shoulder arthroplasty registry Started in 1999 Almost all Swedish hospitals participate. Located at a major Swedish data center in Lund, Sweden > 90% of all swedish shoulder arthroplasties are reported

4. Swedish shoulder arthroplasty registry 2011 > 8100 primary reports since 1999 > 600 (8 %) were re-operations. About 1000 reports yearly –covers >90%

5. News 2011 Webbased report function. SITHS card authorisation of user. New database at RCSyd. New possibilities for analyse.

6. The swedish shoulder arthroplasty registry Primary report: Primary and revision arthroplasties Diagnosis Arthroplasty concept Name of prosthesis Surgical method Complications WOOS score – some shoulder units

7. The swedish shoulder arthroplasty registry Revision surgery reported 1 year, 5 years and 10 years follow-up with self-evaluated score WOOS score EQ-5D

8. Registered Swedish shoulder arthroplasties 1999 – 2011 Annual reports

9. Hemi-arthroplasty Degenerative or post traumatic conditions Displaced 3-4 part fractures of the proximal humerus

10. Hemi-arthroplasties (HHR) Annual reports

11. Hemi-arthroplasty Traditional hemi-arthroplasty with stemmed prosthesis last years also short stem prosthesis Bi-polar arthroplasty Resurfacing prosthesis

12. Hemi-arthroplasties 1999 – 2011 (Fracture prosthesis excluded)

13. Anatomical total shoulder arthroplasty Traditional total shoulder arthroplasty as originally described by Neer Requires a stable shoulder with well functioning rotator cuff More technically demanding for the surgeon than hemiarthroplasty

14. Anatomical total shoulder arthroplasty (TSR)1999 – 2011 Annual reports

15. Results 2009 Of the 2666 primary reports during 1999- 2004 –57% answered. –20% was dead (or lost address). –23% did not answer. The 5 year WOOS was analysed.

16. Results WOOS 5 year Rheumatoid 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 Osteoarthrosis –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

17. Revisions 2009 Among 637 reported re-operations, we had the index-operation in the register for 218 shoulders. Of these –62 shoulders OA –41 shoulders RA

18. Revisions until 2009 Osteoarthritis 1999-2009 (n=2625) –HSA: 37 revisions for Glenoid / 1311 (2,8%) –TSA: 3 revisions for Glenoid / 852(0,4%) Rheumatoid arthritis 1999-2009 (n=1070) –HSA: 16 revisions for Glenoid / 634(2,5%) –TSA: 2 revisions for Glenoid / 192(1%) Bipolar: 3 revisions for Glenoid / 39(8%)

19. Reverse total shoulder arthroplasty Delta reverse shoulder arhroplasty described by Grammont 1993 Anders Ekelund in Stockholm started to evaluate the prosthesis in Sweden During the last 5 – 10 years more frequent used at the major shoulder centers in Sweden More complex cases

20. Reverse shoulder arthroplasties in Sweden 1999 – 2011 Annual reports

21. Reverse total shoulder arthroplasty in Sweden 1999 - 2011 1999 – 2007 almost all reverse shoulder arthoplasties were Delta 3 Since 2007 most reverse shoulder arthroplasties were Delta Xtend but during the last years other prosthesis also have been reported

22. Reverse total shoulder arthroplasty in Sweden 1999 – 2011 Indications Rotator cuff arthropathy Osteoarthrosis Rheumatoid arthritis Acute fracture Sequele after fracture Revision arthroplasty

23. Reverse shoulder arthroplasties in Sweden 1999 - 2011 Annual reports

24. Revision surgery 1999 – 2011 Annual reports

25. Summary: Trends 1999 – 2011 Hemiarthroplasty (HHR), anatomical total shoulder arthroplasty (TSR) and reverse shoulder arthroplasty

26. Shoulder arthroplasty trends – what do the registries tell us? Swedish registry example Conclusions: There is a marked increase of shoulder arthroplasties in Sweden from 1999 – 2011 Hemiarthroplasties show a modest increase. Resurfacing arthroplasties have decreased and short stem arthroplasties have increased instead. There is a significant increase of both anatomical and reverse total shoulder arthroplasties. Cuffarthropathy, revision cases, fracture sequele as well as acute fractures are treated with reverse shoulder arthroplasty