Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries

ABSTRACT

National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.

KEYWORDS:

• Outcome measurement
• parameters
• prom s
• registry
• shoulder replacement
• shoulder prosthesis

Article highlights

• National registries for shoulder arthroplasty have become more popular in developed countries

• We evaluated 7 national registries (Australia, Great Britain, Denmark, Holland, New Zealand, Norway and Sweden), most are obligatory and the completeness is high

• The connection to outcome measurement tools as PROMs is inconsistent and completeness is limited

• International comparison of registries is nearly impossible due to great differences in registered parameters

• If we want to be able to merge registries we have to agree on the use of a similar set of variables, agree on definitions of failure and loosening and on the use of outcome measurement tools

• International comparison of registries would enable us to compare the results of different implants and procedures. Since a relatively small number of shoulder arthroplasties is performed annually per country the higher number of cases would improve the statistical strength of studies to detect differences between implants, indications and procedures

• A striking observation is that most parameters proven to be relevant to failure (implant-, patient- and surgery-related parameters) are not included in the studied registries

• If we aim for the registries to lead to evidence-based clinical decision-making in shoulder arthroplasty we need agreement on the parameters to include and add outcome measurements that are universally accepted

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.