The first shoulder implant registry started in Finland in 1980, Norway followed in 1994 and nowadays a shoulder registry exists in the United Kingdom, Denmark, Norway, Sweden, Finland, the Netherlands, New Zealand, Australia, Germany, Portugal, and the Kaiser Permanente in California. Registries were set up to detect poor prosthetic designs at an early stage and to provide for the track and traceability of these prostheses. Currently registries are used for implant surveillance, and to assess incidence, indication, type of procedure and revision. The available data can help to estimate the future economic impact on our health care systems, and they can also be used to provide information to benchmark shoulder arthroplasty for ODEP.
Existing registries report on surgeon-derived measures, as key-outcome is revision, but there is an increasing demand of all stakeholders for more patient focused outcome measurements. Ideally registries should relate to patient derived outcome measurements as PROMs to enable us to analyze clinical outcome. In several countries the PROMs are already linked to the registry.
Long-term follow-up is required to exhibit differences in outcome and problems with procedures and implants leading to revision surgery. From what is known from existing national registries, there are large variations in indications and type of surgery. Comparative analysis of national registries is difficult as there is a difference in the parameters and outcome measurements recorded. Merging data from different national registries into a common database would enable us to compare incidence, indication, procedure, but also results, and the higher number of cases in such a database would improve the statistical strength of studies. However, this can only be obtained if we agree to use a similar set of variables and outcome measurements.
Role of the SECEC registry committee
The two main goals of the committee are:
- to advocate the usefulness and importance of national arthroplasty registries to members of the SECEC. If we manage to improve the completeness of the registries this can lead to studies to discover differences between techniques and designs. This will encourage surgeons to use this instrument because it permits to measure and improve the quality of medical care.
- to support collaboration between registries and make recommendations on how to combine existing Shoulder and Elbow registry data in Europe to better inform surgical practice and improve outcomes. Based on the minimum data sets recorded in each existing registry, we have produced a SECEC “minimum data set” that other European countries can consider using if they decide to set up a shoulder or elbow joint replacement registry. This includes patient-related data (age, gender, and diagnosis), operative data (date, arthroplasty type), and data for cases of revision (date, reason for revision, and new arthroplasty type). The SECEC Registry Committee members can offer their assistance to any new emerging registries to share their knowledge.
Incentive of the SECEC registry committee
Since 2020 a SECEC registry committee has joined and efforts are undertaken to set-up a collaboration to build a European shoulder registry. If this initiative is supported by the national orthopedic associations, it can gradually gain popularity which can translate into the willingness to use compatible data on a national scale. The SECEC registry committee is working on the organization of a European rotator cuff collaboration. A Delphi approach is used to determine what variables future rotator cuff registries should include.
Current members are Rui Claro, Eoghan Hurley, Anne Karelse, Petra Magosh, Oliver Schoierer and Jeppe Rasmussen.
Recomended publications on registry data within the last 3 years
Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty. Marie L. Jensen, Steen L. Jensen, Matthijs Bolder, Klaus W.J. Hanisch, Anne Kathrine B. Sørensen, Bo S. Olsen, Thomas Falstie-Jensen, Jeppe V. Rasmussen. J Shoulder Elbow Surg (2023) 32, 111–120. Conclusion: There is an increased risk of revision owing to PJI after RSA for patients with previous rotator cuff repair. We recommend that patients with previous rotator cuff repair be regarded as high-risk patients when considering RSA.
The reliability of revision rates following primary shoulder arthroplasty as a quality indicator to rank hospital performance: a national registry analysis including 13,104 shoulders and 87 hospitals. Lotje A. Hoogervorst, Peter van Schie, Jochem Nagels, Rob G.H.H. Nelissen, MD, Perla J. Marang-van de Mheen. J Shoulder Elbow Surg (2023) 32, 59–67. Conclusion: Considerable between-hospital variation was observed for 1- and 3-year revision rates following primary SA, where outlier hospitals could be identified based on large differences in revision for specific indications to direct quality improvement initiatives.
Effect of glenosphere size on reverse shoulder arthroplasty revision rate: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Page R, Beazley J, Graves S, Rainbird S, Peng Y.J Shoulder Elbow Surg. 2021 Dec 27:S1058-2746(21)00861-2. Conclusion: Glenospheres <38 mm can be expected to increase revision rates in primary RTSAs. The optimum size of glenospheres is gender, age, and prosthesis specific, with revision rates lower for females with 38-40-mm glenospheres and lower for males with >40-mm glenospheres.
Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries. Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde LF, Pouliart N. Expert Rev Med Devices. 2021 Dec 23:1-13.Conclusion: The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.
A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthroplasty with a Cemented All-polyethylene Glenoid: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry. Gill DRJ, Page BMedSci RS, Graves SE, Rainbird S, Hatton A. Clin Orthop Relat Res. 2021 Oct 1;479(10):2216-2224. Conclusion: Given the absence of survivorship differences at 4 years between rTSA and aTSA, but in light of the differences in the revision risk between men and women, surgeons might select an aTSA with an all-polyethylene glenoid to treat OA, despite the current popularity of rTSA.
Floor and Ceiling effects in the Oxford Shoulder Score: An analysis from the National Joint Registry. Harvinder P. Singh, Aziz Haque, Nick Taub, Amit Modi, Alison Armstrong, Amar Rangan, Radhakant Pandey. Bone Joint J 2021;103-B (11):1717–1724, org/10.1302/0301-620X.103B11.BJJ-2021-0668.R1
Stem retention and survival in revision of anatomical convertible shoulder arthroplasty to reverse arthroplasty: a Dutch registry study. Theelen LMA, Mory B, Venkatesan S, Spekenbrink-Spooren A, Janssen L, Lambers Heerspink FO. BMC MusculoskeletDisord. 2021 Apr 28;22(1):396. Conclusion: Although convertible designs are gaining popularity due to their expected advantage in revision arthroplasty, surgeons should be aware that during a revision procedure in 27.5% of the patients an unforeseen stem revision is necessary.
Patients undergoing shoulder arthroplasty for failed nonoperative treatment of proximal humerus fracture have low implant survival and low patient-reported outcomes: 837 cases from the Danish Shoulder Arthroplasty Registry. Mechlenburg I, Rasmussen S, Unbehaun D, Amundsen A, Rasmussen JV. Acta Orthop. 2020 Jun;91(3):319-325. Conclusion: Shoulder arthroplasty for PHF sequelae was associated with a high risk of revision and a poor patient-reported outcome. Men treated with RTSA had a high risk of revision.
Low risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures. Lehtimäki K, Rasmussen JV, Kukkonen J, Salomonsson B, Arverud ED, Hole R, Fenstadt AM, Brorson S, Jensen SL, Äärimaa V. JSES Int. 2020 Jan 2;4(1):151-155. Conclusion: The use of RSA for acute PHFs is increasing in the Nordic countries. The short-term risk of revision is low. The main reason for revision of RSA for this indication is instability.
What Factors are Associated with Revision or Worse Patient-reported Outcome after Reverse Shoulder Arthroplasty for Cuff-tear Arthropathy? A Study from the Danish Shoulder Arthroplasty Registry. Amin Baram, Mette Ammitzboell , Stig Brorson, Bo Sanderhoff Olsen, Alexander Amundsen, Jeppe V. Rasmussen. Clin Orthop Relat Res (2020) 478:1089-1097. Conclusion: The results from the present study can be used to inform patients about their individual risk of revision or a disappointing functional outcome. The study also demonstrates the need for proper patient selection and attention to technical details to reduce the risk of revision, especially for men.
A comparison of the minimum data sets for primary shoulder arthroplasty between national shoulder arthroplasty registries. Is international harmonization feasible? Aveledo R, Holland P, Thomas M, Ashton F, Rangan A. Shoulder Elbow. 2019 Jul;11(2 Suppl):48-55. Conclusion: Several similarities were identified between the current national registries that could become unified with only minor changes by a few registries, highlighting the potential feasibility of MDS harmonisation.
Low revision rate despite poor functional outcome after stemmed hemiarthroplasty for acute proximal humeral fractures: 2,750 cases reported to the Danish Shoulder Arthroplasty Registry. Amundsen A, Rasmussen JV, Olsen BS, BrorsonS. Acta Orthop. 2019 Jun;90(3):196-201. We report the revision rate of SHA for acute proximal humeral fractures and the proportion of arthroplasties that are not revised despite low functional outcome scores. We found a high implant survival rate, but also a high proportion of patients with a low functional outcome score 1 year after surgery.
Increased use of total shoulder arthroplasty for osteoarthritis and improved patient-reported outcome in Denmark, 2006–2015: a nationwide cohort study from the Danish Shoulder Arthroplasty Registry. Jeppe V Rasmussen, Alexander Amundsen, Anne Kathrine B Sorensen, Tobias W Klausen, John Jakobsen, Steen L Jensen and Bo S Olsen. Acta Orthopaedica 2019; 90 (5): 489–494 489. Conclusion: We found an increased WOOS score from 2006 to 2015, which was primarily related to a higher proportion of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty towards the end of the study period, and to improved outcome of anatomical total shoulder arthroplasty.
The short-term survival of total stemless shoulder arthroplasty for osteoarthritis is comparable to that of total stemmed shoulder arthroplasty: a Nordic Arthroplasty Register Association study. Jeppe V. Rasmussen, Jenni Harjula, Erica D. Arverud, Randi Hole, Steen L. Jensen, Stig Brorson, Anne Marie Fenstad, Bjorn Salomonsson, Ville Aarimaa. J. Shoulder Elbow Surg (2019) -, 1-9. Conclusion: The short-term survival of total stemless shoulder arthroplasty appears comparable with total stemmed shoulder arthroplasty, but longer observation time is needed to confirm whether they continue to perform equally.
Reverse shoulder arthroplasty has a higher risk of revision due to infection than anatomical shoulder arthroplasty: 17 730 primary shoulder arthroplasties from the Nordic Arthroplasty Register Association. Moeini S, Rasmussen JV, Salomonsson B, Domeij-Arverud E, Fenstad AM, Hole R, Jensen SL, Brorson S. Bone Joint J. 2019 Jun;101-B(6):702-707. Conclusion: The overall incidence of revision due to infection was low. The increased risk in reverse shoulder arthroplasty must be borne in mind, especially when offering it to men.
A review of the New Zealand National Joint Registry to compare the outcomes of Coonrad-Morrey and Latitude total elbow arthroplasty. Viswanath AI, Frampton CM, Poon PC. J Shoulder Elbow Surg. 2020 Apr;29(4):838-844. In New Zealand, the most commonly used prosthesis is the Coonrad-Morrey prosthesis, but the Latitude prosthesis has gained in popularity, with a 3-fold increase in implantation over the past 5 years.
Surgical approaches for total elbow arthroplasties using data from the Dutch Arthroplasty Register. Prkić A, Koenraadt KLM, Viveen J, van Steenbergen L, The B, Eygendaal D.J Shoulder Elbow Surg. 2019 Oct;28(10):2017-2022. Therefore, nationwide databases help to provide more insight into factors that might influence implant survival, for example, the surgical approach used. Using data from the Dutch Arthroplasty Register, we aimed to reveal whether high-volume centers use different approaches.
Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events: a registry-based study. Nestorson J, Rahme H, Adolfsson L.J Shoulder Elbow Surg. 2019 Apr;28(4):e104-e110. BACKGROUND: Primary prosthetic replacement has become an accepted method for the treatment of complex distal humeral fractures. The present study investigated implant survival and adverse events related to this procedure based on available Swedish registries.
Summaries of annual reports of national registries