International trends in shoulder replacement: a meta-analysis from 11 public joint registers
DOI:
https://doi.org/10.2340/17453674.2024.40948Keywords:
Anatomic shoulder replacement, Covid-19, Incidence, International trends, International variation, National Arthroplasty registryAbstract
Background and purpose: International variation exists in the types of shoulder replacement used for treatment of specific diseases. Implant choice continues to evolve without high-quality evidence. Our aim was to evaluate trends in incidence rates of shoulder replacement and assess any recent changes in practice between countries by using registry data.
Methods: Patient characteristics, indication and year of surgery, type of replacement, and collection methods of patient-reported outcomes (PROMs) was extracted from 11 public joint registries. Meta-analyses examined use of reverse total shoulder replacement (RTSR) for osteoarthritis, cuff tear arthropathy, and acute fracture; use of anatomical total shoulder replacement (TSR) for osteoarthritis; and use of humeral hemiarthroplasty for fracture.
Results: The annual growth rate of shoulder replacements performed is 6–15% (2011–2019). The use of RTSR has almost doubled (93%). RTSR is now universally performed for cuff tear arthropathy (97.3%, 95% confidence interval [CI] 96.0–98.1). Its use for avascular necrosis, trauma, and inflammatory arthropathy is increasing. The use of RTSR was similar (43.1%, CI 30.0–57.2) versus TSR (44.7%, CI 31.1–59.1) for osteoarthritis. The types of PROMs used, collection time points, and response rates lack standardization. COVID-19 had a varying inter-registry impact on incidence rates.
Conclusion: The incidence of shoulder replacements has grown. Use of RTSR has increased for all disease indications despite limited high-quality evidence driving this change in indications outside of cuff arthropathy. Consequently, less variation is observed in international practice. Existing differences now relate to use of newer implant types and methodology of PROMs collection, which prevents international comparison and outcome analysis.
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Lübbeke A, Rees J L, Barea C, Combescure C, Carr A J, Silman A J. International variation in shoulder arthroplasty. Acta Orthop 2017; 88(6): 592-9. doi: 10.1080/17453674.2017.1368884. DOI: https://doi.org/10.1080/17453674.2017.1368884
Pinkas D, Wiater J, Spencer E, Edwards T, Uribe J, Declercq G, et al. Shoulder prosthetic arthroplasty options in 2014: what to do and when to do it. Instr Course Lect 2015; 64: 193-202. PMID: 25745905
Singh J A, Sperling J, Buchbinder R, McMaken K. Surgery for shoulder osteoarthritis. Cochrane Database Syst Rev 2010; 10. doi: 10.1002/14651858.CD008089.pub2. DOI: https://doi.org/10.1002/14651858.CD008089.pub2
Craig R S, Goodier H, Singh J A, Hopewell S, Rees J L. Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Syst Rev 2020; 21(4). doi: 10.1002/14651858.CD012879.pub2. DOI: https://doi.org/10.1002/14651858.CD012879.pub2
International Society of Arthroplasty Registries (ISAR). Members (ISAR). Available from: https://www.isarhome.org/members2023
National Joint Registry (NJR). National Joint Registry 18th Annual Report 2021. Available from: reports.njrcentre.org.uk; 2021.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, knee & shoulder arthroplasty: 2020 Annual Report. Australian Orthopaedic Association (AOA); 2020. Available from: https://aoanjrr.sahmri.com/annual-reports-2020
New Zealand Joint Registry. The New Zealand Joint Registry: 22 Year Report; 2020 1st June 2023. Available from: https://www.nzoa.org.nz/annual-reports
Dansk Skulderalloplastik Register (DSR). Årsrapport 2022; June 21, 2023. Available from: https://www.sundhed.dk/sundhedsfaglig/kvalitet/kliniske-kvalitetsdatabaser/planlagt-kirugi/skulderalloplastik/
Svenska Skulder och Armbags Registret. ÅRSRAPPORT 2020 Svenska Skulder och Armbågsregistret: Innehåller resultat avseende 1999–2020. Available from: http://www.ssas.se/axel/reports.php; 2020.
Nasjonal Kompetansetjeneste for Leddproteser og hoftebrudd. Report June 2020: Norwegian National Advisory Unit on Arthroplasty and Hip Fractures. Helse Bergen HF DoOS, Hospital HU; 2020. Available from: https://helse-bergen.no/nasjonal-kompetansetjeneste-for-ledd-proteser-og-hoftebrudd/arsrapporter#annual-reports
Dutch Arthroplasty Register (LROI). Online LROI annual report 2020: Joint arthroplasty data to December 31, 2019; 2021. Available from: https://www.lroi-report.nl/
American Academy of Orthopedic Surgeons (AAOS). Shoulder & Elbow Registry (SER): The second annual report of the SER on shoulder and elbow procedural data 2021. Available from: https://www.aaos.org/registries/publications/ser-annual-report/
DVSE. Schulterprothesenregister: Jahresbericht 2020. SwissRDL Medical Registry and Data Linkage; 2020. Available from: https://www.dvse.info/organisation/prothesenregister.html
Regional Register of Orthopaedic Prosthetic Implantology. Overall data hip, knee and shoulder arthroplasty in Emilia-Rogagna Region (Italy) 2000–2019. Emilia Romagna: Servizio Sanitario Regionale; 2022. Available from: https://ripo.cineca.it/authzssl/pdf/Annual%20report%202019%20RIPO%20Register_v2.pdf
Klug A, Herrmann E, Fischer S, Hoffmann R, Gramlich Y. Projections of primary and revision shoulder arthroplasty until 2040: facing a massive rise in fracture-related procedures. J Clin Med 2021; 10(21 (5123)). doi: 10.3390/jcm10215123. DOI: https://doi.org/10.3390/jcm10215123
Longo U G, Papalia R, Castagna A, De Salvatore S, Guerra E, Piergentili I, et al. Shoulder replacement: an epidemiological nationwide study from 2009 to 2019. BMC Musculoskelet Disord 2022; 23(1): 889. doi: 10.1186/s12891-022-05849-x. DOI: https://doi.org/10.1186/s12891-022-05849-x
Rasmussen J V, Jakobsen J, Brorson S, Olsen B S. The Danish Shoulder Arthroplasty Registry: clinical outcome and short-term survival of 2,137 primary shoulder replacements. Acta Orthop 2012; 83(2): 171-3. doi: 10.3109/17453674.2012.665327. DOI: https://doi.org/10.3109/17453674.2012.665327
Institute for Health and Welfare. Finnish Arthroplasty Register 2023 [updated March 4, 2023. Available from: https://www.thl.fi/endo/report/#data/shoulder_incidence.
Italian Arthroplasty Registry. Annual Report 2020. riap.iss.it; 2020. Available from: https://riap.iss.it/riap/en/activities/reports/2022/11/23/annual-report-2020-english-addendum/
Office of National Statistics (ONS). Population estimates for the UK, England and Wales, Scotland and Northern Ireland: ONS; 2023. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates
Australian Bureau of Statistics (ABS). National, state and territory population: Statistics about the population and components of change (births, deaths, migration) for Australia and its states and territories ABS2023. Available from: https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release
Statistisk sentralbyra (Statistics Norway). National Population Projections ssb.no2023. Available from: https://www.ssb.no/en/befolkning/befolkningsframskrivinger/statistikk/nasjonale-befolkningsframskrivinger
Statistics New Zealand (Stas NZ). National population estimates 2023. Available from: https://www.stats.govt.nz/information-releases/national-population-estimates-at-30-june-2019
Statistics Denmark. Denmark in Figures. dst.dk: Denmakr Stastistics; 2023. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates https://www.dst.dk/da/
Statistisches Bundesamt (Destatis). Current population: population by nationality and sex destatis.de2023. Available from: https://www.destatis.de/EN/Themes/Society-Environment/Population/Current-Population/Tables/lrbev02a.html
Statline SN. Population dynamics; month and year 2023. Available from: https://opendata.cbs.nl/statline/#/CBS/en/dataset/83474ENG/table?ts=1692441697752
Viechtbauer W. Bias and efficiency of meta-analytic variance estimators in the random-effects model. J Educ Behav Stat 2005; 30(3): 261-93. doi: 10.3102/10769986030003261, http://www.jstor.org/stable/3701379 DOI: https://doi.org/10.3102/10769986030003261
Higgins J P, Thompson S, Deeks J, Altman D G. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557. doi: 10.1136/bmj.327.7414.557. DOI: https://doi.org/10.1136/bmj.327.7414.557
Higgins J P T, Green S. Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration; 2011. Available from: http://handbook.cochrane.org
Higgins J P, Thompson S, Spiegelhalter D J. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172(1): 137-59. doi: 10.1111/j.1467-985X.2008.00552.x. DOI: https://doi.org/10.1111/j.1467-985X.2008.00552.x
Günsche J L, Pilz V, Hanstein T, Skripitz R. The variation of arthroplasty procedures in the OECD countries: analysis of possible influencing factors by linear regression. Orthop Rev 2020; 12(3). doi: 10.4081/or.2020.8526. DOI: https://doi.org/10.4081/or.2020.8526
Shichman I, Roof M, Askew N, Nherera L, Rozell J, Seyler T, et al. Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040–2060. LID - e22.00112. JB JS Open Access 2023; 28(1). doi: 10.2106/JBJS.OA.22.00112. DOI: https://doi.org/10.2106/JBJS.OA.22.00112
Westermann R W, Pugely A J, Martin C T, Gao Y, Wolf B R, Hettrich C M. Reverse shoulder arthroplasty in the United States: a comparison of national volume, patient demographics, complications, and surgical indications. Iowa Orthop J 2015; 35: 1-7. PMCID: PMC4492145.
Jain N B, Yamaguchi K. The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg, 2014; 23(12): 1905-12. doi: 10.1016/j.jse.2014.06.055. DOI: https://doi.org/10.1016/j.jse.2014.06.055
Institution for Health Metrics and Evaluation. Global Burden of Disease. Seattle, WA: IHME, University of Washington; 2019. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates; https://vizhub.healthdata.org/gbd-results/
National Institute for Health and Care Research (NIHR). Reverse or anatomical (replacement) for painful shoulder osteoarthritis: differences between interventions. Acronym; RAPSODI NIHR2023. Available from: https://fundingawards.nihr.ac.uk/award/NIHR133418
National Institute for Health and Care Research (NIHR). Improving outcomes for patients having shoulder replacements: guiding patient selection, evaluating cost-effectiveness and informing NHS provision. NIHR; 2023. Available from: https://fundingawards.nihr.ac.uk/award/NIHR301474
Jonsson E Ö, Ekholm C, Salomonsson B, Demir Y, Olerud P, Etzner M, et al. Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial. J Shoulder Elbow Surg 2021; 30(5): 994-1006. doi: 10.1016/j.jse.2020.10.037. DOI: https://doi.org/10.1016/j.jse.2020.10.037
Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures: a blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 2014; 23(10): 1419-26. doi: 10.1016/j.jse.2014.06.035. DOI: https://doi.org/10.1016/j.jse.2014.06.035
Gill SA-O, Graves S, Lorimer M, de Steiger R, Ackerman I A-O, Ellis A, et al. COVID-19 impact on joint replacement surgery in Australia in 2020: a nationwide perspective. ANZ J Surg 2022; 92(1-2): 10-3. doi: 10.1111/ans.17343. DOI: https://doi.org/10.1111/ans.17343
Organization for Economic Cooperation and Development (OECD). Health at a Glance: Europe 2022 (State of Health in the EU Cycle). Paris: OECD; 2022.
Rolfson O, Bohm E, Franklin P, Lyman S, Denissen G, Dawson J, et al. Patient-reported outcome measures in arthroplasty registries: report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87(eSuppl 362): 9-23. doi: 10.1080/17453674.2016.1181816. DOI: https://doi.org/10.1080/17453674.2016.1181816
Rasmussen J V, Olsen B S, Fevang B T, Furnes O, Skytta E T, Rahme H, et al. A review of national shoulder and elbow joint replacement registries. J Shoulder Elbow Surg 2012; 21(10): 1328-35. doi: 10.1016/j.jse.2012.03.004. DOI: https://doi.org/10.1016/j.jse.2012.03.004
Rangan A, Gwilym S, Keding A, Corbacho B, Kottam L, Arundel C, et al. Reverse shoulder arthroplasty versus hemiarthroplasty versus non-surgical treatment for older adults with acute 3- or 4-part fractures of the proximal humerus: study protocol for a randomised controlled trial (PROFHER-2: PROximal Fracture of Humerus Evaluation by Randomisation - Trial Number 2). Trials 2023; 24(1): 270. doi: 10.1186/s13063-023-07259-3. DOI: https://doi.org/10.1186/s13063-023-07259-3
Hughes R E, Batra A, Hallstrom B R. Arthroplasty registries around the world: valuable sources of hip implant revision risk data. Curr Rev Musculoskelet Med 2017; 10(2): 240-52. doi: 10.1007/s12178-017-9408-5. DOI: https://doi.org/10.1007/s12178-017-9408-5
Lübbeke A, Silman A J, Barea C, Prieto-Alhambra D, Carr A J. Mapping existing hip and knee replacement registries in Europe. Health Policy 2018; 122: 548-57. doi: 10.1016/j.healthpol.2018.03.010. DOI: https://doi.org/10.1016/j.healthpol.2018.03.010
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Copyright (c) 2024 Neal Rupani, Christophe Combescure, Alan Silman, Anne Lübbeke, Jonathan Rees
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