Revision surgery following total shoulder arthroplasty

Analysis of 2588 shoulders over three decades (1976 to 2008)

J. A. Singh, J. W. Sperling, R. H. Cofield

Abstract

Our objective was to examine the rate of revision and its predictive factors in patients undergoing total shoulder arthroplasty (TSA). We used prospectively collected data from the Mayo Clinic Total Joint Registry to examine five-, ten- and 20-year revision-free survival following TSA and the predictive factors. We examined patient characteristics (age, gender, body mass index, comorbidity), implant fixation (cemented versus uncemented), American Society of Anesthesiologists class and underlying diagnosis. Univariate and multivariable adjusted hazard rates were calculated using Cox regression analysis. A total of 2207 patients underwent 2588 TSAs. Their mean age was 65.0 years (19 to 91) and 1163 (53%) were women; osteoarthritis was the underlying diagnosis in 1640 shoulders (63%). In all, 212 TSAs (8.2%) were revised during the follow-up period. At five, ten and 20 years, survival rates were 94.2% (95% confidence interval (CI) 93.2 to 95.3), 90.2% (95% CI 88.7 to 91.7) and 81.4% (95% CI 78.4 to 84.5), respectively. In multivariable analyses men had a higher hazard ratio of revision of 1.72 (95% CI 1.28 to 2.31) (p < 0.01) compared with women, and those with rotator cuff disease had a hazard ratio of 4.71 (95% CI 2.09 to 10.59) (p < 0.001) compared with patients with rheumatoid arthritis. We concluded that male gender and rotator cuff disease are independent risk factors for revision after TSA. Future studies are needed to understand the biological rationale for these differences.

Footnotes

  • The authors would like to thank S. Harmsen and C. Schleck for the statistical analyses and Y. Lochler for providing the study cohort. This study is the result of work supported by National Institute of Health (NIH) Clinical Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research) and the resources and the use of facilities at the Birmingham VA Medical Center, Alabama. The study sponsors had no role in the study design, the collection, analysis and interpretation of data, the writing of the manuscript or in the decision to submit the manuscript for publication. There are no financial conflicts related to this work. J. A. Singh has received speaker honoraria from Abbott; research and travel grants from Allergan, Takeda, Savient, Wyeth and Amgen; and consultant fees from Savient, URL pharmaceuticals and Novartis. J. W. Sperling has received royalties from Aircast and Biomet, consultant fees from Tornier and owns stock in Tornier. R. H. Cofield has received royalties from Smith and Nephew.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Received February 28, 2011.
  • Accepted July 20, 2011.
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