Jamie S Brown1, Robert J Gordon2, Yi Peng3, Alesha Hatton3, Richard S Page4, Kelly A Macgroarty5. 1. Brisbane Knee and Shoulder Clinic, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia; Lund University Clinical Sciences, Helsingborg, Sweden. Electronic address: jamiesutherlandbrown@yahoo.co.uk. 2. Orthopaedics Toowoomba, Toowoomba, QLD, Australia. 3. South Australian Health and Medical Research Institute, Adelaide, SA, Australia. 4. Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital, Geelong, VIC, Australia; School of Medicine, Deakin University, Waurn Ponds, VIC, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia. 5. Brisbane Knee and Shoulder Clinic, Brisbane, QLD, Australia.
Abstract
BACKGROUND: Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. METHOD: Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: <10, 10-20, and >20 shoulder arthroplasty cases per surgeon, per year. RESULTS: There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the <10/yr compared with the >20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P = .009). For reverse total shoulder arthroplasty (rTSA) performed for OA, there was a higher revision rate for the <10/yr compared with the >20/yr group for the first 3 months only (HR 2.58, 95% CI 1.67-3.97, P < .001). In rTSA for cuff arthropathy, there was a significantly higher rate of revision for the <10/yr compared with the >20/yr group throughout the follow-up period (HR 1.66, 95% CI 1.21-2.28, P = .001). There was no significant difference for the primary diagnosis of fracture. CONCLUSION: Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. Despite increases in the volume of shoulder arthroplasties performed in recent years, more than 78% of surgeons undertake fewer than 10 procedures per year.
BACKGROUND: Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. METHOD: Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: <10, 10-20, and >20 shoulder arthroplasty cases per surgeon, per year. RESULTS: There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the <10/yr compared with the >20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P = .009). For reverse total shoulder arthroplasty (rTSA) performed for OA, there was a higher revision rate for the <10/yr compared with the >20/yr group for the first 3 months only (HR 2.58, 95% CI 1.67-3.97, P < .001). In rTSA for cuff arthropathy, there was a significantly higher rate of revision for the <10/yr compared with the >20/yr group throughout the follow-up period (HR 1.66, 95% CI 1.21-2.28, P = .001). There was no significant difference for the primary diagnosis of fracture. CONCLUSION: Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. Despite increases in the volume of shoulder arthroplasties performed in recent years, more than 78% of surgeons undertake fewer than 10 procedures per year.
Keywords:
Australian Orthopaedic Association National Joint Replacement Registry; Total shoulder arthroplasty; arthroplasty register; reverse shoulder arthroplasty; revision rate; surgical volume; total shoulder replacement
Authors: Sambit Sahoo; José A Rodríguez; Matthew Serna; Kurt P Spindler; Kathleen A Derwin; Joseph P Iannotti; Eric T Ricchetti Journal: Semin Arthroplasty Date: 2021-02-13