Total Shoulder Arthroplasty or Hemiarthroplasty: A Comparison of Complication Rates in the English National Health Service

Abstract

Background There is debate regarding the benefit of glenoid resurfacing in shoulder arthroplasty. The present study aimed to compare the complication rates of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA). This is the first study to compare complication rates on a national scale. Methods Data were extracted from the Hospital Episode Statistics database for patients who underwent planned TSA or HA between 2005 and 2008 in the English National Health Service. Medical and surgical complications, as well as 18-month revision rates, were analysed for the whole cohort (9804 patients). A subset of 939 with longer follow-up was examined for 5-year revision rates. Results The 18-month revision rate was significantly higher in the TSA group (3.03% versus 1.76%; odds ratio = 1.75; 95% confidence interval = 1.33 to 2.28) but, at 5 years, there was no difference (3.85% versus 3.67%; odds ratio = 0.95; confidence interval = 0.46 to 1.91). The overall in-hospital 90-day mortality rate was 0.43%. There were no significant differences in 30-day readmission, wound complication and reoperation rates. The incidence of medical problems was low. Conclusions Despite concerns regarding osteolysis around the glenoid component after TSA, the present study reports no significant differences in complication rates between the groups at 5 years. However, the controversy surrounding glenoid resurfacing is likely to continue.