Session 11: Shoulder/Elbow
Fredag den 23. oktober
09:00 – 10:00
Lokale: Stockholm/Copenhagen
Chairmen: Bo S. Olsen / Jeppe V. Rasmussen
117. Thirty-day, ninety-day and one-year mortality after shoulder replacement: 5,853 primary operations reported to the Danish Shoulder Arthroplasty Registry
Alexander Amundsen, Jeppe V. Rasmussen, Stig Brorson, Bo Sanderhoff Olsen
Orthopaedic, Herlev Hospital
Background: Mortality and risk factors associated
with shoulder arthroplasty has been
sparsely reported compared to knee and
hip arthroplasty.
Purpose / Aim of Study: The primary aim was to quantify the
thirty-day, ninety-day and one-year
mortality after primary shoulder
arthroplasty and compare it to the
general population. An assessment of the
association between mortality, surgical
diagnoses and causes of death was
performed.
Materials and Methods: 5,853 primary operations from 2006 to
2012 were included and information about
the patients was obtained from the
Danish Shoulder Arthroplasty Register
and the Danish Cause of Death Register.
Incidences in the general population
were calculated with data from
Statistics Denmark and compared to the
patients.
Findings / Results: The mean age was 69.3 (± 11.6) years and
69.2 % were women. Thirty-nine (0.7 %)
patients died within thirty days,
eighty-eight (1.5 %) within ninety days
and 222 (3.8 %) within one year.
Fracture patients had a higher mortality
than patients with elective diagnoses.
The overall incidence of death within
thirty days was 666 per 100,000.
Fracture patients had an over five times
higher incidence of death than the
general population within thirty days.
Deaths occurring within thirty days were
due to cardiac (20.5 %) and abdominal
causes (20.5 %).
Conclusions: The mortality at thirty days (0.7 %),
ninety-days (1.5 %) and one-year (3.8 %)
was significantly higher than that of
the general population. There was a
trend that mortality rates balanced in
the patients and the general population
one year after shoulder arthroplasty.
Fracture patients had higher mortality.
Patients with osteoarthritis and rotator
cuff arthropathy are relatively safe in
terms of mortality when undergoing
shoulder arthroplasty. Pulmonary,
cardiac and abdominal causes of death
were the most common in the short-term
group.
118. Evaluation of the clinical practice of shoulder examination among ten experienced shoulder surgeons
Ann Ganestam, Mikkel Attrup, Per Hölmich, Kristoffer W Barfod
Orthopedic surgery, Hvidovre Hospital
Background: Shoulder problems constitute a major socioeconomic
problem with lifetime prevalence up to 66.7%. To aid
diagnosis more than 184 tests have been described.
Although a standardized guideline for a complete
shoulder examination is not available, we
hypothesize that experienced shoulder surgeons
have clear preferences among shoulder physical
examination tests.
Purpose / Aim of Study: The aims of this study was to identify the most used
shoulder physical examination tests for 12 selected
shoulder pathologies and evaluate the usefulness of
these tests in terms of sensitivity and specificity
Materials and Methods: In March to May 2014, ten experienced shoulder
surgeons were asked to name the shoulder physical
examination tests they would use for 12 pre-selected
shoulder pathologies. A literature search on
Pubmed.com and on the Cochrane library was
conducted to assess the sensitivity and specificity of
the most reported shoulder physical examination
tests for each pathology to investigate specificity and
sensitivity of the test
Findings / Results: In total 49 shoulder physical examination tests were
named. For eight of 12 pathologies at least 9
surgeons reported at least one common shoulder
physical examination test. Eight surgeons agreed on
one test for one pathology. For the remaining three
pathologies six surgeons recommended one
common test. The sensitivity and specificities of the
12 chosen tests were acceptable.
Conclusions: There was a high degree of agreement on which
shoulder physical examination to use for which
shoulder pathology and the specificity and sensitivity
of the most reported shoulder physical examination
tests for each pathology were both acceptable.
However, there is no clear evidence to support one
shoulder physical examination test over another in
the literature
119. Shoulder function, pain and health related quality of life in adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type
Birgit Juul-Kristensen, Elise Johannessen, Helle Reiten, Silje Maeland , Helene Løvaas
Institute of Sports Science and Clinical Biomechanics , University of Southern Denmark, Odense, DK; Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, N; Institute of Occupational Therapy, Physiotherapy and Radiography , Bergen University College, Bergen, N; Uni Research Health, Bergen, N; Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, N
Background: The shoulder is a frequently reported
pain area and associated with shoulder
instability in patients with Joint
Hypermobility Syndrome (JHS) and Ehlers
Danlos-hypermobility type (EDS-HT). No
studies have reported the nature of
shoulder function in this group.
Purpose / Aim of Study: To investigate characteristics of
shoulder function, pain and health
related quality of life (HRQoL) in
adults with JHS/EDS-HT, compared with
the general population (controls).
Materials and Methods: Through postal survey 110 patients
diagnosed with JHS/EDS-HT from two
Norwegian hospitals, and 140 gender- and
age-matched healthy controls from
Statistics Norway were invited. Shoulder
function from Western Ontario Shoulder
Instability Index (WOSI), pain from
Numerical Pain Rating Scale (NPRS) and
pain drawing chart, in addition to HRQoL
from the 36-item Short Form (SF-36) were
registered.
Findings / Results: Totally, 81 individuals responded, with
an overall response rate of 34%
(JHS/EDS-HT: 53% vs. controls: 21%).
JHS/EDS-HT had significantly lower
shoulder function (WOSI total: 49.9 vs.
83.3; p<0.001), general physical
function (SF-36, Physical Component
scale: 28.1 vs 49.9; p<0.001), and
higher pain intensity (NRS: 6.4 vs. 2.7;
p<0.001) than controls. Further,
JHS/EDS-HT more often reported
generalized pain (96%). Neck and
shoulder joints were most frequently
rated as painful areas, with
significantly higher frequency in
JHS/EDS-HT than controls (90% vs 27%;
80.% vs 37%), for the neck and the
shoulder, respectively.
Conclusions: Adults with JHS/EDS-HT have impaired
shoulder function, increased pain
intensity and more often generalized
pain, as well as reduced physical HRQoL
compared with the general population.
Neck and shoulder joints were the most
often painful areas in both groups,
however, with significantly higher
frequency in JHS/EDS-HT.
120. Patient-reported outcome following revision of resurfacing hemiarthroplasty in patients with glenohumeral osteoarthritis.
Jeppe Rasmussen, Stig Brorson, Ali Al-Hamdani, Bo S Olsen
Department of Orthopaedic Surgery, Herlev Hospital
Background: Resurfacing hemiarthroplasty (RHA) has
a bone preserving design facilitating
revision to other arthroplasty designs.
For this reason, a high revision rate may
be acceptable. However, the argument
is only valid as long as the RHA can be
revised to a satisfactory result.
Purpose / Aim of Study: The aim of this study was to report the
outcome and the need for further
surgery following revision of RHA in
patients with osteoarthritis.
Materials and Methods: We reviewed all patients with
osteoarthritis reported to the Danish
Shoulder arthroplasty registry between
2006 and 2013. There were 1,210 RHA,
of which 111 (9%) required revision.
WOOS was accessed at 1 year and the
need for re-revision were recorded.
Findings / Results: 40 RHA were revised to stemmed
hemiarthroplasty, 30 to anatomical total
shoulder arthroplasty and 31 to reverse
total shoulder arthroplasty. Median
WOOS scores for these 3
subpopulations were 48, range 5-97; 74,
range 20-97; and 68, range 22-97
respectively. The median WOOS scores
for primary stemmed hemiarthroplasty,
total shoulder arthroplasty and reverse
shoulder arthroplasty were 74, range 0-
100; 93, range 0-100; and 67, range 0-
100. The differences for stemmed
hemiarthroplasty (P=0.003) and total
shoulder arthroplasty (P=0.003) were
statistically significant and the
differences exceeded the minimal
clinically important difference. 11 (10%)
patients were re-revised mainly
because of deep infection (n=6).
Conclusions: For a revision procedure, the outcome
following revision of RHA is acceptable,
but the results are inferior to that of
primary stemmed hemiarthroplasty and
primary anatomical total shoulder
arthroplasty. The revision of RHA is
associated with a high risk of infection.
Thus, anatomical total shoulder
arthroplasty remain our preferred choice
in the treatment of osteoarthritis and
RHA is reserve for selected cases only.
121. The Nordic Arthroplasty Register Association experience: 19,857 primary shoulder replacement reported from 2004-2013.
Jeppe Rasmussen, Steen Lund Jensen, Stig Brorson
Department of Orthopaedic Surgery, Herlev Hospital
Background: The Nordic Arthroplasty Register
Association (NARA) was initiated in
2007 by hip and knee surgeons and
several unique papers have been
published.
Purpose / Aim of Study: We aimed to examine the feasibility of
merging data from the Nordic national
shoulder arthroplasty registries by
defining a common minimal data set.
Furthermore, we used data from the
dataset to report the incidence of
shoulder replacement; and finally, we
compared data from the individual
registries.
Materials and Methods: In 2014, a group of surgeons met to
examine the feasibility of merging data
from the national shoulder registries in
Denmark, Norway and Sweden.
Differences in definitions and variables
were discussed. A common minimal
dataset was defined as a set of
variables containing only data that all
registries could deliver and where
consensus according to definition of the
variables could be made.
Findings / Results: We agreed upon a dataset containing
patient-related data including diagnosis,
operative data including implant design
and data in case of revision including
reason and new implant. 19857 primary
arthroplasties were reported from 2004-
13. The number of replacements
increased in the study period. With 13
replacements/100,000/year the
incidence of shoulder replacement in
Denmark was nearly twice the incidence
in Norway. In Sweden, 50% of the
implants used for osteoarthritis were
total shoulder arthroplasties whereas in
Denmark, 56% were resurfacing
hemiarthroplasties and only 16% total
shoulder arthroplasties. In Norway, 17%
with a fracture were replaced with
reverse shoulder arthroplasty compared
to 4% in Denmark.
Conclusions: We were able to merge data from the
national registries into one common
dataset; however, the set of details was
reduced. In future studies we will
compare arthroplasty designs regarding
revision rates and reasons for revision.
122. Unscheduled contacts after outpatient shoulder arthroscopy - Preliminary results from an observational follow-up study
Lone Dragnes Brix, Theis Muncholm Thiellemann, Karen Toftdahl Bjørnholdt, Lone Nikolajsen
Department of Anaesthesiology, Horsens Regional Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Ortopaedic , Horsens Regional Hospital
Background: Outpatient shoulder surgery has grown
considerably over the past two decades.
Good pain management after outpatient
surgery is essential to make a short
recovery time, early discharge and rapid
return to daily living. Unfortunately,
several studies have shown that pain is
one of the most common complications of
outpatient surgery. Severe pain remains
a major problem and can lead to
unscheduled contacts to healthcare
professionals after discharge.
Purpose / Aim of Study: To assess the frequencies and causes of
unscheduled contacts with healthcare
professionals after outpatient shoulder
arthroscopy within the first week after
surgery with special emphasis on pain.
Materials and Methods: Outpatients scheduled for elective shoulder
arthroscopy including subacromial
decompression and acromioclavicular joint
resection were enrolled at the Day Surgery
Unit at Horsens Regional Hospital. One week
after surgery patients received an electronic
questionnaire containing questions about the
post-discharge period.
Findings / Results: A total of 135 consecutive patients were
enrolled. After discharge, 24.4 % of patients
contacted healthcare professionals, 10 %
had more than one unscheduled contact.
Pain and prescription of pain medication
were the leading causes for contact. Most
contacts were made the day after surgery
by telephone to the general practitioner.
Even though 94 % of all patients reported to
have received sufficient information and
guidance regarding pain and pain-treatment
after discharge, the most frequent result of
contact was information and guidance
combined with prescription of pain
medication.
Conclusions: Unscheduled contacts to healthcare
professionals after outpatient shoulder
arthroscopy are a problem. Expected future
findings in present study: Unscheduled
contacts after outpatient surgery differ
according to surgical procedures.
123. Outcome after shoulder replacement for failed osteosynthesis in proximal humerus fractures. A registry-based study of 293 cases.
Marc Randall Kristensen, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen, Stig Brorson
Department of Orthopaedic Surgery, Herlev Hospital
Background: Some patients with a failed osteosynthesis
of a proximal humerus fracture are re-
operated by joint replacement, but it has not
been reported if previous osteosynthesis is
a significant risk factor for inferior outcome
after shoulder replacement.
Purpose / Aim of Study: To study if previous osteosynthesis is a risk
factor for inferior outcome following
shoulder replacement.
Materials and Methods: A matched case-control study based on
data from the Danish Shoulder Arthroplasty
Registry (DSR). All patients with shoulder
arthroplasty after failed osteosynthesis of a
proximal humerus fracture reported to DSR
from 2006-13 were reviewed. Each case
was matched with two controls based on
age, gender and completeness of Western
Ontario Osteoarthritis of the Shoulder index
(WOOS). The controls had a primary
shoulder replacement of a proximal
humerus fracture. We compared WOOS
and the relative risk of revision.
Findings / Results: 293 shoulder arthroplasties after failed
osteosynthesis and 586 controls were
included. Mean WOOS of the cases was
45.7 and of the controls 52.2. The difference
of 6.5 points (95% CI 2.1-10.8; p=0.004) in
favor of primary arthroplasty was statistically
significant. 10.6% of the cases and 6.0% of
the controls were revised, making the
relative risk of revision 1.8 (95% CI 1.1-2.9;
p=0.023).
Conclusions: WOOS was statistically significantly inferior
in patients with shoulder replacement after
failed osteosynthesis, but the difference
may not be clinically relevant. However, we
also found a significantly higher revision
rate in patients with shoulder arthroplasty
after failed osteosynthesis. Osteosynthesis
should not be used as primary surgical
treatment of proximal humerus fractures to
delay shoulder replacement, and we
advocate that peroperative conversion from
osteosynthesis to shoulder arthroplasty is
possible.
124. Rasch analysis of The Western Ontario Osteoarthritis of the Shoulder (WOOS) index – the Danish version
Sahar Moeini, Stig Brorson, Tobias Wirenfeldt Klausen, Jeppe V. Rasmussen
Department of Orthopedic Surgery, Herlev Hospital; Department of Hematology, Herlev Hospital
Background: The Western Ontario Osteoarthritis of the Shoulder
(WOOS) index is a disease-specific patient-reported
19-question survey that measures quality of life
among osteoarthritis (OA) patients. WOOS is used
for the evaluation of shoulder arthroplasty in patients
reported to the Danish Shoulder Arthroplasty
Register (DSR).
Purpose / Aim of Study: The purpose of this study was to validate the Danish
version of WOOS for OA patients and secondly for
other diagnoses through modern test theory.
Materials and Methods: The study included 2416 arthroplasties in 2298
patients reported to DSR between 2006 and 2011.
Five diagnoses were included: 100 rheumatoid
arthritis; 847 osteoarthritis; 161 rotator cuff
arthropathy; 1140 fracture; and 168 revisions.
We tested the fit of different diagnoses to the Rasch
model. The dimensionality of WOOS was further
examined with residual Principal Component Analysis
(PCA). WOOS was regarded as dichotomous in the
study.
Findings / Results: A dichotomous scale was the best fit for WOOS. The
analysis of the OA patients had a good reliability and
showed adequate targeting and a good fit to the
model. The analysis of fracture (FR) patients
showed an even better fit and higher reliability. The
WOOS items fitted well to the OA sample except
from two items, item 5 and 6. In addition, item 6
showed signs of degrading the scale. Only item 6
showed misfit for FR patients and there was no sign
of scale degradation. The residual PCA confirmed
unidimensionality for FR patients but not for OA
patients. Six items displayed clinically significant
Differential Item Functioning between OA and FR
patients.
Conclusions: The Rasch analysis generally suggested that WOOS
can be considered valid and representative for
quality of life level of both OA and FR patients.
Surprisingly, FR had the best fit to WOOS even
though WOOS is originally made for OA.