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Surgeon results and experience With total shoulder arthroplasty
In the recent Journal of Bone and Joint Surgery article regarding surgeon experience and results with total shoulder arthroplasty, Dr. Pietrobon of Duke University, demonstrated that patients who have a total shoulder arthroplasty performed by a high volume surgeon or at high volume hospital are more likely to have a better outcome than patients who have the procedure performed by a surgeon with lesser experience or in a hospital that does fewer of these complex surgeries.
This interesting paper is the first of its kind. No previous study has ever been performed to determine the relationship between volume and outcomes for shoulder arthroplasty. The conclusion of this paper was that patients who have a total shoulder arthroplasty performed by a high volume surgeon or in a high volume hospital are more likely to have a better outcome. Surgeons were separated into three groups: low volume, medium volume, and high volume. Amazingly, high volume surgeons were only required to do five total shoulder arthroplasties per year and low volume surgeons did fewer than two total shoulder arthroplasties per year. In this country, surgeons to do fewer than two total shoulder arthroplasties per year do about 33.5% of all of the total shoulder arthroplasties that are performed in this country. The surgeons that perform high volume surgery, five or greater, only perform 28.9% of all of the total shoulder arthroplasties that are performed each year.
As opposed to total knee replacement surgery, where the surgeon might do several hundred total knee procedures per year, total shoulder arthroplasty is much less commonly performed. A busy shoulder surgeon might do three or four hundred shoulder operations per year. Out of all of these surgeries, only 30 to 60 of the surgeries might be a total shoulder arthroplasty. Indeed, in order to be categorized as a high volume surgeon in this study the surgeon had to only perform five or more total shoulder arthroplasties in one year. Most of the very famous shoulder surgeons of the world perform more than 25 total shoulder arthroplasties per year. According to this study, surgeons who do not perform this operation more than once or twice a year do not have the same results as surgeons who perform this operation more frequently.
At our office, we do about 40 total shoulder arthroplasties each year. We do make every attempt at being up to date and pride ourselves on our experience and our volume. We keep track of our results and have data to back up what we believe to be quality results. Ask your surgeon how many total shoulders he performs each year.
Journal of Bone and Joint Surgery, 2004, 86A, p. 496. |
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