Nikolas K Knowles1, Melanie P Columbus2, Kilian Wegmann3, Louis M Ferreira1, George S Athwal4. 1. Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada. 2. Division of Emergency Medicine, Department of Medicine, The University of Western Ontario, London, ON, Canada. 3. Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany. 4. Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada. Electronic address: gathwal@uwo.ca.
Abstract
BACKGROUND: Joint registries provide invaluable data on primary arthroplasties with revision as the endpoint; however, the revision outcomes are often excluded. Therefore, a PROSPERO registered review (CRD42015032531) of all revision studies in North America and Europe was conducted to evaluate demographics, etiologies and indications, implant manufacturer, and complications by geographic region. METHODS: The MEDLINE, EMBASE, and CENTRAL databases were searched for revision arthroplasty clinical studies with a minimum mean 24-month follow-up. There were no language exclusions. Articles published in German, French, and Italian were reviewed by research personnel proficient in each language. RESULTS: The mean age at revision was 66 ± 5 years (male = 759, female = 1123). The male-female ratio in North American and Europeans studies was 43:57 and 34:66, respectively. The most common etiology for primary surgery in both regions was osteoarthritis or glenoid arthrosis (38%). The most common revision indication overall was rotator cuff tear, deficiency, or arthropathy (26%). The most common implant type used in revisions was a reverse shoulder arthroplasty (54%). The complication rate for all revisions was 17%. There were a total of 465 complications, and of those, 74% lead to a reoperation. CONCLUSION: Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure, based on the published studies included in this systematic review. Additionally, of the complications, a large number (74%) went on to a reoperation. Further insight into the reasons for early revisions and standardized reporting metrics and data collection on revisions is needed.
BACKGROUND: Joint registries provide invaluable data on primary arthroplasties with revision as the endpoint; however, the revision outcomes are often excluded. Therefore, a PROSPERO registered review (CRD42015032531) of all revision studies in North America and Europe was conducted to evaluate demographics, etiologies and indications, implant manufacturer, and complications by geographic region. METHODS: The MEDLINE, EMBASE, and CENTRAL databases were searched for revision arthroplasty clinical studies with a minimum mean 24-month follow-up. There were no language exclusions. Articles published in German, French, and Italian were reviewed by research personnel proficient in each language. RESULTS: The mean age at revision was 66 ± 5 years (male = 759, female = 1123). The male-female ratio in North American and Europeans studies was 43:57 and 34:66, respectively. The most common etiology for primary surgery in both regions was osteoarthritis or glenoid arthrosis (38%). The most common revision indication overall was rotator cuff tear, deficiency, or arthropathy (26%). The most common implant type used in revisions was a reverse shoulder arthroplasty (54%). The complication rate for all revisions was 17%. There were a total of 465 complications, and of those, 74% lead to a reoperation. CONCLUSION: Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure, based on the published studies included in this systematic review. Additionally, of the complications, a large number (74%) went on to a reoperation. Further insight into the reasons for early revisions and standardized reporting metrics and data collection on revisions is needed.