THE SCOTTISH REGISTER OF SHOULDER ARTHROPLASTY – THE RESULTS AT FIVE YEARS

Abstract

All known shoulder surgeons in Scotland have made a voluntary registration of shoulder replacements since 1996. Information regarding diagnostic and demographic characteristics of the patients, rotator cuff status and type of procedure performed were collated.

20 surgeons have contributed to the register, performing a varied number of shoulder arthroplasties (2 to 79). By five years the total number of shoulder replacements performed was 451. 23. 2 % of patients were male and 76. 8% female. 397 patients had a hemiarthroplasty and 54 (12 %) had a total shoulder replacement. 204/451 (45 %) humeral components used were cemented. In comparison 48/54 (89%) glenoid components used were cemented.

The most common condition requiring shoulder arthroplasty was inflammatory arthritis (184 cases), followed by trauma (128 cases), of which 60 % were for acute trauma and 40 % for old trauma. The remainder consisted of osteoarthritis (87 cases), avascular necrosis (27 cases), and others (25 cases). The consultant in 425 cases and the trainee in 26 cases performed the operation. In 85/451 (18. 9%) of the cases, associated procedures were performed which included cuff repair (26 cases), coracoacromial ligament excision (43 cases), coracoid osteotomy (14 cases) and acromioclavicular joint excision (2 cases). There were 24 intra-operative complications and 9 patients had a revision.

Comparison with figures from the Information and statistics division in Scotland however indicated that our register collected only 53 % of all the arthroplasties performed. In addition it was noted that 30 % of shoulder replacements were performed by surgeons who performed three or fewer shoulder replacements a year.

In an age of clinical governance we believe that a register can provide detailed and accurate information. It is useful for demonstrating current practice and can highlight future changes in practice.

This register supports the need for a national register and surveillance of shoulder replacements. However, in addition to the voluntary data registration, it is proposed that dedicated data collection staff are employed to coordinate the data collection process.