ShoulderRisk factors for revision surgery after humeral head replacement: 1,431 shoulders over 3 decades
Section snippets
Study population
The Mayo Clinic Joint Registry was used to conduct this study. This prospective registry has captured every arthroplasty performed at the Mayo Clinic, Rochester, Minnesota, USA, since 1969, including all shoulder arthroplasties performed since 1976. The Mayo Clinic medical center provides primary and specialty care to residents of Olmsted County and specialty care to referred patients. All patients who undergo shoulder arthroplasty are invited to return for a clinic visit at 1, 2, and 5 years
Clinical characteristics
The patient characteristics are summarized in Table I. During the study period (1976-2008), 1,359 patients underwent 1,431 shoulder HHRs. The mean age was 63 years, 63% of patients were female, and the mean BMI was 28 kg/m2; 60% of implants were cemented. The ASA class was 1 or 2 in 49% and 3 or 4 in 51%. The mean cohort follow-up was 7 years (SD, 7 years; range, 1 day to 32 years) with median follow-up of 5 years.
Revision rates
Of the 1,413 shoulders that underwent HHR, 114 were revised during the follow-up.
Discussion
In this study, which included 1,359 patients with 1,431 shoulder HHRs performed over a 33-year period, we found that 85% were revision free at 20-year follow-up. Although in univariate analyses several variables were associated with a higher risk of revision, including male gender, older age, higher BMI, higher ASA class, and underlying diagnosis, in multivariate analyses we found that only younger age and higher BMI were significantly associated with a higher risk of revision. To our
Conclusion
This study provides the revision-free survival rate for HHR up to 20-year follow-up. The revision-free survival rate at 20-year follow-up after HHR was good, at 85%. Higher BMI and younger age were significant risk factors for revision surgery, whereas other patient factors such as gender, comorbidity, ASA class, and underlying diagnoses were not associated with revision risk. Studies are needed to explore the reasons for higher revision rates in obese patients undergoing HHR and to examine the
Acknowledgments
We thank Scott Harmsen, MS, and Cathy D. Schleck, BS, for performing statistical analyses and Youlonda Lochler for providing the study cohort.
Disclaimer
This material is the result of work supported by National Institute of Health Clinical Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research) and the resources and use of the facilities at the Birmingham VA Medical Center. The study sponsors had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
The authors, their
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This study was approved by the Mayo Clinic Institutional Review Board, and all investigations were conducted in conformity with ethical principles of research.