Valsamis Epaminondas Markos, Beck Larsen Josefine, Thillemann Theis M, Gwilym Stephen E, Collins Gary S, Mechlenburg Inger, Rees Jonathan L
Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, , University of Oxford, Oxford, OX3 7LD, UK.
NIHR Oxford Biomedical Research Centre, Oxford, UK.
BMC Med. 2025 Mar 26;23(1):180. doi: 10.1186/s12916-025-04003-3.
The incidence of shoulder replacement surgery continues to rise internationally. The aim of this study was to compare revision surgery, reoperations and serious adverse events after shoulder replacement surgery in England and Denmark.
Linked National Joint Registry and NHS Hospital Episode Statistics of England, and linked Danish Shoulder Arthroplasty Registry and Danish National Patient Registry data were available from 1 April 2012 to 31 December 2020. All primary shoulder replacements in adult patients were included. Revision surgery, reoperations and serious adverse events were compared between the two countries, and stratified by procedure type and surgical indication. The risk of revision and serious adverse events were adjusted for age, sex and comorbidities, using flexible parametric survival models and logistic regression models, respectively.
A total of 41,471 and 9,268 primary shoulder replacement procedures were analysed from England and Denmark, respectively. The mean patient age in Denmark was 70.6 years (SD 10.1) and in England 72.6 years (SD 9.9). Danish patients had a lower risk of serious adverse events (4.5%) compared to patients in England (5.6%), but a slightly higher risk of re-operations by 1 year (Denmark 2.3% [95% CI 2.0% to 2.6%], England 1.7% [95% CI 1.6% to 1.8%]). There was a slightly lower risk of revision joint replacement surgery by 8 years in Denmark (5.1% [95% CI 4.5% to 5.8%]) compared to England (5.7% [95% CI 5.4% to 6.1%]). The reverse total shoulder replacement had a higher revision rate in Denmark, but the anatomical total shoulder replacement and humeral hemiarthroplasty had lower revision rates. Denmark had a considerably higher revision rate for patients having surgery for acute trauma. These results remained the same after adjusting for age, sex, and the Charlson Comorbidity Index.
While there was variation in the demographics of patients having shoulder replacement surgery in England and Denmark, differences in serious adverse events and revision rates were observed despite case-mix adjustment. Some of this variation might be attributed to the differences seen in the use of different procedures for different surgical indications between the two countries.
在国际上，肩关节置换手术的发生率持续上升。本研究的目的是比较英格兰和丹麦肩关节置换手术后的翻修手术、再次手术及严重不良事件。
可获取2012年4月1日至2020年12月31日期间英格兰国家关节注册中心与国民健康服务体系医院事件统计数据的关联数据，以及丹麦肩关节置换注册中心与丹麦国家患者注册中心的数据。纳入所有成年患者的初次肩关节置换病例。比较两国之间的翻修手术、再次手术及严重不良事件，并按手术类型和手术指征进行分层。分别使用灵活参数生存模型和逻辑回归模型，对年龄、性别和合并症进行调整后，分析翻修和严重不良事件的风险。
分别对英格兰的41471例和丹麦的9268例初次肩关节置换手术进行了分析。丹麦患者的平均年龄为70.6岁（标准差10.1），英格兰患者为72.6岁（标准差9.9）。与英格兰患者（5.6%）相比，丹麦患者发生严重不良事件的风险较低（4.5%），但1年内再次手术的风险略高（丹麦2.3%[95%置信区间2.0%至2.6%]，英格兰1.7%[95%置信区间1.6%至1.8%]）。与英格兰（5.7%[95%置信区间5.4%至6.1%]）相比，丹麦在8年内进行翻修关节置换手术的风险略低（5.1%[95%置信区间4.5%至5.8%]）。丹麦的反式全肩关节置换翻修率较高，但解剖型全肩关节置换和肱骨半关节置换的翻修率较低。丹麦急性创伤手术患者的翻修率显著更高。在对年龄、性别和查尔森合并症指数进行调整后，这些结果仍然相同。
虽然英格兰和丹麦进行肩关节置换手术的患者人口统计学特征存在差异，但尽管进行了病例组合调整，仍观察到严重不良事件和翻修率存在差异。这种差异部分可能归因于两国在针对不同手术指征使用不同手术方式上的差异。
