1. Shoulder Fracture Arthroplasty Björn Salomonsson 2009 Björn Salomonsson 2009

2. Started 1999  Swedish Shoulder Arthroplasty Register  www.ssas.se/axel  Swedish Shoulder Arthroplasty Register  www.ssas.se/axel

3. 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).

4. 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).

5. 10 years 1999-2008  1267 patients has answered by returning complete self evaluating WOOS score to the Shoulder register 5 years after the surgery.  The surgery was performed 1999-2003 and the 5-year follow-up analysed was performed during 2004-2008.  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 1999-2003 and the 5-year follow-up analysed was performed during 2004-2008.  1184 of the patients had a primary arthroplasty at the index operation.

6. Results: Fracture Arthroplasty at 5 years 1999-2003  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%

7. 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.

8. Re-operation burden for fracture is low.

9. But the failures are early?

10. 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 / 100 000 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 / 100 000 inhabitants  Fractures  Resurfacing in Osteoarthritis

11. Incidens in Sweden and Denmark  All shoulders / 2007

12. 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%

13. Surgery timing Denmark/Sweden

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

15. Result: 5 year WOOS % for FX diagnosis

16. Result in WOOS % 5 years 1999-2003 Number of Fx / Hospital 1999-2008

17. 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?

18. 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?

19. Distribution in Sweden 2007-2008

20. Distribution by percentage

21. Choice of treatment  Fracture surgery in Stockholm 2007- 2008  Differences between Hospitals  Fracture surgery in Stockholm 2007- 2008  Differences between Hospitals

22. Choice of treatment in Stockholm

23. Fracture arthroplasty in Stockholm

24. Implants for fracture 1999-2008

25. 2000 2002 2004 2005

26. Danish fracture implants 2007

27. WOOS 5 years for fx implants 1999-2003

28. Thank You!