Shoulder Fracture Arthroplasty Bjrn Salomonsson 2009 Started 1999

Shoulder Fracture Arthroplasty Björn Salomonsson 2009

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

Started by SSAS w 5 -year follow-up by WOOS-score. w Pilot 1 -year follow-up by WOOS-score (and pre-op WOOS). w 10 -year follow-up by WOOS-score (started 2009).

2009 w >6400 reports of shoulder arthroplasty w 7 % re-operations. w WOOS score w >300 answers, 1 year (pilotstudy). w >1400 answers, 5 year. w (10 year starting 2009).

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

Results: Fracture Arthroplasty at 5 years 1999 -2003 w Fractures: (median) WOOS % of healthy shoulder w Hemiarthroplasty (n = 380) WOOS 64% w < 2 weeks to surgery (n=315) w > 2 weeks to surgery (n=65) WOOS 68% WOOS 61% w Malunion (n=34) w Non union (n=33) WOOS 56% WOOS 43%

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.

$Re-operation burden for fracture is low.$

Re-operation burden for fracture is low.

But the failures are early?

Comparison to the Danish register 2007 w Danish/Swedish Register (2007) w Age distribution and (mean) age are very similar w Distribution of diagnosis are very similar w Denmark do more surgery / 100 000 inhabitants w Fractures w Resurfacing in Osteoarthritis

Incidens in Sweden and Denmark w All shoulders / 2007

Results from timing and volume w WOOS 1 år (median) score, (aim 50%): w Denmark <2 weeks n=359 w w w < 20 /year 20 -<40 /year =>40 /year w Denmark >2 weeks n=162 SWE 5 y 57% 68% 52% 56% 62% 46% 61%

Surgery timing Denmark/Sweden

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

Result: 5 year WOOS % for FX diagnosis

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

$The future? w New or coming trends in treatment of proximal humeral fracturs: w$

The future? w New or coming trends in treatment of proximal humeral fracturs: w w Locking plates? Increasing Arthroplasty? Increasing Early arthroplasty surgery? Better than late! Reversed shoulder arthroplasty? Even better?

Proximal Humeral Fracture w Classification? w Choice of treatment? w Circulation? w Keep the humeral head? w Later Caput necrosis? w Osteoporosis? w Fixation? w Bony healing? w Soft tissue quality? w Rotator cuff balance? w Muscle function? w Patient Outcome? w Satisfaction? w Function? w Pain?