Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018

The purpose of this study is to identify and analyze primary revision arthroplasties of the shoulder in the Germany Shoulder Arthroplasty Registry. The objective is to provide demographic and clinical data of the included cases and information about the revision surgery itself and to compare the findings to other registry studies and clinical studies.

All documented cases of primary revision arthroplasties of the Germany Shoulder Arthroplasty Registry in the time period 2014-2018 (n = 975) were included in the initial data analysis. Exclusion criteria were multiple revisions and data sets with a missing link of the revision arthroplasty to the data set of the primary implantation leaving n = 433 cases that were included. SPSS software (IBM SPSS Statistics for Windows, version 24.0; IBM Corp., Armonk, NY, USA) was used for statistical analyses.

The age of patients with revised anatomic implants (66.3 years) was significantly lower than that of patients with reverse implants (77.1 years) (P = .001). Female patients with anatomic and fracture implants were significantly older than their male counterparts (70.1 vs. 60.5 years, P = .001; 74.3 vs. 62 years, P = .019) and showed a significantly higher rate of revision than their male counterparts (P = .001). The reason for revision was significantly different for anatomic and reverse implant systems (P = .001). Aseptic loosening of either the humeral or glenoid component was the most common reason for revision for anatomic implants, whereas unspecified reasons, dislocation, and loosening of the glenosphere were the most common reasons for reverse implants. The most common type of revision procedure for anatomic implants was conversion to a reverse system in about one third of the cases. Most of the revisions of reverse implants were not specified and almost equally distributed for revision at the humeral or the glenoid side. Anatomic implants showed significantly better Constant-Murley scores (26.1 points) than reverse implants (19.6 points) (P = .001) and significantly better function before revision for passive flexion (P = .002), passive abduction (P = .015), active external rotation (P = .002), and passive external rotation (P = .002).

This study provides a well-documented basis to compare revision arthroplasties of the shoulder performed in Germany over the last decade as documented in the nationwide registry with other nationwide registries and with clinical studies. Especially, the detailed analysis of intraoperative and postoperative complications and the shoulder function at the time of revision offers new information in addition to the results of other registries.