INITIAL FINDINGS AFTER THE IMPLEMENTATION OF A REGIONAL SHOULDER ARTHROPLASTY REGISTRY

The volume of shoulder replacement procedures worldwide has increased dramatically over the last decade with growth exceeding rates reported for hip and knee. Arthroplasty registries are widespread and have contributed to reducing revision and complication rates. The Canadian Joint Replacement Registry (CJRR) was established in 2001 to capture information on the outcomes of hip and knee replacement care in Canada. There is currently no national total shoulder arthroplasty (TSA) database in Canada. The provincial (Blinded for Review) was initiated for total shoulder arthroplasty in 2017 with the goal of providing a model for national expansion. This study outlines the characteristics and patient-reported outcomes of procedures captured in the registry. All patients undergoing primary or revision anatomic TSA (aTSA) and reverse TSA (rTSA) in the province since 2017 were included. Emergent and hemi-arthroplasty cases were excluded. Patient-reported data were collected in-clinic at baseline, and by mail-out one year postoperatively and included the American Society of Shoulder and Elbow Surgeon Score (ASES), EuroQol five-dimension health survey (EQ-5D), satisfaction, and self-reported complications. Intra-operative arthroplasty related details were collected at the time of surgery with the surgeon signature required for completeness. ASES and EQ-5D were compared for primary aTSA and rTSA subgroups pre-operatively and postoperatively using a two-sample two-sided t-test. The provincial shoulder database included 985 TSA, of which 67% were aTSA (661/985). Overall, 94% (927/985) were primary and 6% (58/985) were revision procedures. Four primary patients (0.43%) were linked with revision cases within the first year following surgery (4/927). Eighty-nine percent of primary TSA patients (aTSA=92%; rTSA=81%) and 63% of revision TSA patients (aTSA=58%; rTSA=73%) reported being “Satisfied” or “Very Satisfied” one year postoperatively. The rate of patient-reported complications (dislocation/superficial infection/deep infection/future surgery) was lower for primary procedures (aTSA=1%; rTSA=2%) than revision procedures (aTSA=12%; rTSA=5%). There was significant improvement in both ASES and EQ-5D scores from the preoperative to postoperative timepoints in primary aTSA (ASES mean change 48.5 [95% CI 45.4 to 51.6]; p Primary TSA provided significant improvement in ASES and EQ-5D scores one year postoperatively. Greater improvement was observed in the primary aTSA subgroup compared to rTSA. Lower satisfaction and a higher prevalence of self-reported complications was observed in patients undergoing revision TSA, specifically when revised to an aTSA. This study outlines the successful implementation of a regional TSA registry in Canada and demonstrates the potential for a shoulder arthroplasty database to be integrated within the current CJRR system. Integration with larger administrative databases, improving patient response rates, and national expansion to other provinces within Canada are next steps for the shoulder arthroplasty registry.