The Swedish Shoulder Arthroplasty Register. 1999-2006
5-year follow-up by WOOS-score in 616 primary shoulder arthroplasties.
1999-2006
Experiences after 8 years
Ulf Lillkrona Anders Nordqvist Hans Rahme Björn Salomonsson
The Swedish Shoulder and Elbow Society´s, Board of Quality Registers
THE REGISTER
• It is owned by SSAS. • Will change plattform to get an internet report solution. • Cooperation with the NKO.
REGISTER AIM:
• Earlier identification of problems. • Obtain results for:
Designe Technique Diagnose
REPORTS
• Simple, 2 minutes. (Internet in 2007) • 5-year follow-up by mail. • WOOS, EQ-5D.
WOOS-SCORE
• • • • •
Well documented. Diagnose-specific. Patient self-evaluating. Validation in Swedish. The same score in Denmark.
PROBLEMS
• Missing information <5% • Missing reports <10%
Trauma-surgeons? Local organisation! Uncertain comparison!
• 2 Hospitals do not report!
REPORTS -2006
Total 3871 reports (255 / 3616)
Re-operation 7%
Primary arthroplasty 93%
COMMON DIAGNOSIS
The most common diagnoses
1328 1400
1200 911 1000 717 800
600
400
200
0 Reumatoid Arthrosis Fracture
The Swedish Shoulder Arthroplasty Register. 1999-2006
5year follow-up by WOOSscore in 616 primary shoulder arthroplasties.
AIM:
• To examine the functional outcome of primary shoulder arthroplasties that were reported to the Swedish National Registry. • This was conducted as a self evaluation with a WOOS-score. • 5 years after surgery.
MATERIAL:
• All patients with a report of a shoulder arthroplasty to the Swedish National Registry is asked to complete a WOOS score 5 years after the reported surgery. • The registry started in 1999, and until 2001, 1238 primary shoulder arthroplasties were reported.
5-YEAR WOOS-SCORE REPLY
Number of Primary 1999-2001
1400
1200
1000
800 1238 600
Replies 1999-2001
400
616
200
0 1 2
5-YEAR WOOS F.U.
5-year follow-up
Deceased 15%
Missing 5%
Mail 80%
5-YEAR WOOS REPLY
Mail 5-year follow-up
No reply 38%
Reply 62%
5 YEAR WOOS-SCORE
• 616 patients from 42 different hospitals completed the mailed WOOS-score and returned it to the register by mail during 2004-2006. • The WOOS score i presented as a percentage of a normal shoulder function.
RESULTS:
• The WOOS score was calculated for different patient selections. • Males were fewer (n=170) but had a higher median WOOS score of 73,5% compared to females (n=446) 62%.
5-YEAR WOOS GENDER
WOOS % 5-year MALE / FEMALE
80
70
60
50 73,5 62 30
40
20
10
0 1 2
RESULTS:
• • • • • • • Nonunion n=15, WOOS 38% Osteonekrosis n=20, WOOS 53,5% Cuff arthropaty n=24, WOOS 57,5% Reumatoid arthritis n=146, WOOS 62% Fractures n=197, WOOS 65% Secondary arthrosis n=31, WOOS 66% Osteoarthrosis n=141, WOOS 79%
5 YEAR WOOS DIAGNOSE
WOOS % / Diagnos 5 år
80
70
60
50 79 65 66
40 62
Serie1
30
54
58
20
38
10
0 Non union Caputnecrosis Cuff-arthrop Reumatoid Fracture Secondary Arthrosis
RESULTS:
• Comparing different concepts by the median WOOS score: • Hemi arthroplasty
(n=516, WOOS 64%)
• Total arthroplasty
(n=75, WOOS 81%)
5 YEAR WOOS HEMI / TOTAL
5-year WOOS HEMI / TOTAL
81 90
80
64
70
60
50
40
30
20
10
0 Hemi arthroplasty Total arthroplasty
5-YEARS SATISFACTION
One question on patient satisfaction after 5 years was also asked.
5-YEARS SATISFACTION
Satisfaction 5-Years F.U.
40%
35%
34%
30% 30% 26% 25% 27%
29%
23% All Hospitals
20% 17% 17% 15% 14% 14% 15% 16% 13% 13%
> 20 (n=16) < 20 (n=26)
12%
10%
5%
0% Very satisfied Satisfied Either Not satisfied dissatisfied
5-YEARS SATISFACTION
All / Danderyd Hospital
35% 33%
30%
30%
30%
26% 25%
20% 17% 17% All Hospitals Danderyd (n=54) 15% 14% 13% 13%
10% 7%
5%
0% Very satisfied Satisfied Either Not satisfied dissatisfied
5-YEARS WOOS/HOSPITAL
WOOS / Hospital > 10 Answers
80%
70%
60%
50%
40%
WOOS WOOS>25
30%
20%
10%
0% A B C D E F G H I J K L M N O P Q R S T U V X Y Z A B C
5-YEARS WOOS/IMPLANT
Implant WOOS
1 0,9 0,8 72% 0,7 61% 0,6 0,5 0,4 0,3 0,2 0,1 0 WOOS >20 WOOS >50 66% 65% 65% 60% 72%
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IMPLANTS
• A majority of the implants used at the beginning 1999 now is out of market or has a changed design 2007.
CONCLUSION:
• The Swedish Shoulder Arthroplasty Register now is beginning to produce results from a 5 year follow-up.
• The follow-up rate of 50% is not yet enough, but the results will still be able to give an indication of what result to expect from a shoulder arthroplasty in different patient selections.
FURTHER ANALYSIS:
• Analysis will also be made between different implants and hospitals in the next years.
• Change in design of the implants will result in new entities for the analysis.
Thank you!
www.ssas.se
www.ssas.se/axel