Shoulder arthroplasty outcomes audit

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This audit summarizes the first 100 consecutive shoulder arthroplasties performed by a single surgeon between 2013-2016. It found: 1) The majority of procedures were for osteoarthritis or cuff tear arthropathy. The proportion of revisions is increasing. 2) Outcomes were comparable to national joint registry data, with reverse replacements being more common than anatomical replacements. 3) Complication rates were lower than literature reports, with 3 periprosthetic fractures, 2 dislocations, and 1 acromial stress fracture being the main surgical complications.

Audit of 100 consecutive
Shoulder Arthroplasties
S Srinivasan, UL Fellow
Mr P Monga, Consultant.

Aim
• Audit of personal Series of the first 100 consecutive shoulder
Replacements
• Benchmarking Surgical Practice
• Good medical practice
• Patient Information

Methodology
• Single surgeon series
• 1st 100 consecutive shoulder arthroplasties
• NHS(n=87) & Private (n=13).
• Review of electronic case records including EPR,
Bluespier and PACS
• Missing Data- late 2011, 2012

Demographics
• Demographics
• M:F 31:69 (100 shoulders)
• Age Range 50-92 yrs
• Indications
• OA &CTA 71
• RA 2
• Trauma 7
• Other 20 (revision)

Comparison with NJR Data
Parameter 13th NJR Report Our Audit
Indication for primary 75%:13%:3.5% 71%:7%:2%
(OA+CTA : Trauma : RA/Inflamm)

Co-morbidities
• ASA Grade
• Grade 1 - 6
• Grade 2 - 46
• Grade 3 - 33
• Grade 4 - 0
• Not documented - 15

Type of Arthroplasty
7%
28%
45%
5%
15%HemiArthroplasty
Anatomical TSR
Reverse
Stage 1
Revision

Comparison with NJR Data
Parameter 13th NJR Report Our Audit
Anatomical:Reverse:Hemi 34:39:24 28:45:7
Primary: Revision 97:3 80:20

Trends- type of arthroplasty
1
2
3
1
2
4
8
14
6
15
9
15
0
1
2 2
0
2
7
6
0
4
8
12
16
2013 2014 2015 2016
Hemiarthroplasty
Anatomic replacement
Reverse replacement
1st stg revision
Revision of replacement
2013 2014 2015 2016

Reflection
• Proportion of revisions increasing
• Hemi arthroplasty low numbers

Growth
0
10
20
30
40
2013 2014 2015 Till Sep 2016
Further 49 next year

Hemiarthroplasty (n=7)
0
10
20
30
40
2013
2014
2015
2016
Hemiarthroplasty
Total

Reference
19262 TSA and RSA
Mean FU 40.3 months
122 studies
Complications of Shoulder Arthroplasty
Bohsali KI, Bois, A, Wirth M
JBJS Am 2017; 99(3): 256-269

$TSA (Primaries) 0 1 2 3 4 5 Loosening Glenoid wear Instability RC tear PP fracture Neural injury Infection Haematoma Deltoid Injury VTE Bohsali et al Personal data$

RSA (Primaries)
0
1.25
2.5
3.75
5
6.25
Instability PP Fracture Infection Loosening Neural Injury Acromial /
spine #
Haematoma Deltoid injury RC tear VTE

Medical
• DVT post op 1
• Post op Stroke( Post op 1 week) 1
• Chest infection (post discharge) 1
• Intraop arrhythmia 1

$Surgical (Primary+Revision) • Periprosthetic fracture -3 (Humeral Rim fracture 1, Glenoid Rim Fracture 1, Humeral Fracture 1) • Dislocations - 2 • Acromial Stress Fracture - 1$

Summary
• Steady increase in numbers and complexity
(revisions)
• Reverse Polarity > Anatomic
• Resurfacing arthroplasty unreliable outcome
• Complications Rates Lower than Literature controls

Summary
• Limitations
• Patients with Complications such as DVT may
have presented to a different hospital
• Assessment of glenoid wear and loosening
challenging in non standardised X-rays

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Posterior labral injuries commonly occur in rugby players due to the high impact nature of the sport. A video analysis study identified the 'try-scorer', 'direct impact', 'tackler', and 'flexed landing' mechanisms as common causes of these injuries. For patients without prior surgery, an MR arthrogram is recommended to investigate posterior labral injuries, while a CT arthrogram is preferred for those with a history of shoulder surgery. The document then provides brief case histories of three professional rugby players who sustained posterior labral injuries.

Biceps the enigmatic tendon

Puneet Monga

The biceps tendon can be affected by several pathologies due to its unique anatomical arrangement passing through the shoulder joint. The most common pathology seen with biceps tendon involvement is rotator cuff tears, as the biceps tendon passes between the supraspinatus and subscapularis muscles. Other common issues include tenosynovitis due to its intra-articular but extrasynovial location, tendinosis from mechanical forces and wear, and instability from disruption of surrounding ligaments. While the biceps role in shoulder function is debated, management primarily focuses on treating any associated shoulder issues like rotator cuff tears, with tenodesis reserved for symptomatic chronic biceps

Biceps tendon ruptures

Puneet Monga

The document discusses biceps tendon ruptures, including the anatomy of the biceps muscle and different types of ruptures. Proximal ruptures can be traumatic or degenerative and are often associated with rotator cuff tears. Surgical management of proximal ruptures involves long head of biceps tenodesis, though the optimal site and technique are debated. Distal ruptures occur when the tendon is loaded during contraction and early repair is recommended for active individuals with distal ruptures.

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Shoulder arthroplasty outcomes audit

1. Audit of 100 consecutive Shoulder Arthroplasties S Srinivasan, UL Fellow Mr P Monga, Consultant.

2. Aim • Audit of personal Series of the first 100 consecutive shoulder Replacements • Benchmarking Surgical Practice • Good medical practice • Patient Information

4. Methodology • Single surgeon series • 1st 100 consecutive shoulder arthroplasties • NHS(n=87) & Private (n=13). • Review of electronic case records including EPR, Bluespier and PACS • Missing Data- late 2011, 2012

5. Demographics • Demographics • M:F 31:69 (100 shoulders) • Age Range 50-92 yrs • Indications • OA &CTA 71 • RA 2 • Trauma 7 • Other 20 (revision)

6. Comparison with NJR Data Parameter 13th NJR Report Our Audit Indication for primary 75%:13%:3.5% 71%:7%:2% (OA+CTA : Trauma : RA/Inflamm)

7. Co-morbidities • ASA Grade • Grade 1 - 6 • Grade 2 - 46 • Grade 3 - 33 • Grade 4 - 0 • Not documented - 15

8. Type of Arthroplasty 7% 28% 45% 5% 15%HemiArthroplasty Anatomical TSR Reverse Stage 1 Revision

9. Comparison with NJR Data Parameter 13th NJR Report Our Audit Anatomical:Reverse:Hemi 34:39:24 28:45:7 Primary: Revision 97:3 80:20

10. Trends- type of arthroplasty 1 2 3 1 2 4 8 14 6 15 9 15 0 1 2 2 0 2 7 6 0 4 8 12 16 2013 2014 2015 2016 Hemiarthroplasty Anatomic replacement Reverse replacement 1st stg revision Revision of replacement 2013 2014 2015 2016

11. Reflection • Proportion of revisions increasing • Hemi arthroplasty low numbers

12. Growth 0 10 20 30 40 2013 2014 2015 Till Sep 2016 Further 49 next year

13. Hemiarthroplasty (n=7) 0 10 20 30 40 2013 2014 2015 2016 Hemiarthroplasty Total

14. Complications

15. Reference 19262 TSA and RSA Mean FU 40.3 months 122 studies Complications of Shoulder Arthroplasty Bohsali KI, Bois, A, Wirth M JBJS Am 2017; 99(3): 256-269

16. TSA (Primaries) 0 1 2 3 4 5 Loosening Glenoid wear Instability RC tear PP fracture Neural injury Infection Haematoma Deltoid Injury VTE Bohsali et al Personal data

17. RSA (Primaries) 0 1.25 2.5 3.75 5 6.25 Instability PP Fracture Infection Loosening Neural Injury Acromial / spine # Haematoma Deltoid injury RC tear VTE

18. Medical • DVT post op 1 • Post op Stroke( Post op 1 week) 1 • Chest infection (post discharge) 1 • Intraop arrhythmia 1

19. Surgical (Primary+Revision) • Periprosthetic fracture -3 (Humeral Rim fracture 1, Glenoid Rim Fracture 1, Humeral Fracture 1) • Dislocations - 2 • Acromial Stress Fracture - 1

20. Summary • Steady increase in numbers and complexity (revisions) • Reverse Polarity > Anatomic • Resurfacing arthroplasty unreliable outcome • Complications Rates Lower than Literature controls

21. Summary • Limitations • Patients with Complications such as DVT may have presented to a different hospital • Assessment of glenoid wear and loosening challenging in non standardised X-rays

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