Shoulder implant registries

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 with 11 shoulder surgeons from European countries 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 this registry on a national scale. To start with, the SECEC registry committee is working on the organization of a multicenter international trial with approximately 20 centers for registration of shoulder surgery supported by the REDCAP database system. Possibly a database system like this may improve usability for the surgeon. Current members are Rui Claro, Eoghan Hurley, Anne Karelse, Petra Magosh, Oliver Schoierer and Jeppe Rasmussen.

Recent publications on registry data

Shoulder

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. BACKGROUND: Modularity is an integral element of reverse total shoulder arthroplasty (RTSA). Glenosphere diameter is a key component, but its effect on revision rate is unknown.

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. National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery.

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. The study period was set to time-match for the collection of ASA score and BMI in 2012 and 2015, respectively. Our registry enrolls more than 97% of all shoulder arthroplasties undertaken in Australia.

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. In these cases a total revision is necessary. The primary aim of this Dutch registry study was to evaluate the unforeseen stem reversion percentages in revision of convertible anatomical shoulder arthroplasty to reverse shoulder arthroplasty.

Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018. Kircher J, Ohly B, Fal MF, Magosch P, Mauch F. JSES Int. 2021 Feb 9;5(3):382-390.
BACKGROUND: The purpose of this study is to identify and analyze primary revision arthroplasties of the shoulder in the Germany Shoulder Arthroplasty Registry. The objective is to provide demographic and clinical data of the included cases and information.

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. Background and purpose - When nonoperative treatment of proximal humerus fracture (PHF) fails, shoulder arthroplasty may be indicated. We investigated risk factors for revision and evaluated patient-reported outcome 1 year after treatment with either stemmed hemiarthroplasty

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. METHODS: RSA implants for acute PHFs were identified from the Nordic Arthroplasty Register Association registry data from 2004 to 2016. ...The 5-year cumulative implant survival rate was 97% (confidence limits, 95.5% and 98%)

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. Data relating to local or regional registries was excluded. There were nine national shoulder arthroplasty registries reporting a total of 97,388 primary shoulder replacements.

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. Patients and methods - The Danish Shoulder Arthroplasty Registry was used to identify all patient …

Elbow

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.