Purpose Clinical registries are essential for evaluation of surgical outcomes. The Schulthess Shoulder Arthroplasty Registry (SAR) was established in 2006 to evaluate safety, function, quality-of-life and patient satisfaction in patients undergoing shoulder arthroplasty.
Participants Adult patients undergoing anatomic or reverse shoulder joint replacement at the Schulthess Klinik, a high-volume, leading orthopaedic surgery centre in Zürich, Switzerland.
Findings to date Between March 2006 and December 2019, the registry covered 98% of eligible operations. Overall, 2332 patients were enrolled with a total of 2796 operations and 11 147 person-years of follow-up. Mean age at baseline was 71 (range: 20–95), 65% were women. Most common indication was rotator cuff tears with osteoarthritis (42%) and the mean preoperative Constant Score was 31 (±15). The most frequent arthroplasty type was reverse, increasing from 61% in 2006–2010 to 86% in 2015–2019. Functional recovery peaked at 12-month postoperatively and did not show a clinically relevant deterioration during the first ten follow-up years. Since its establishment, the registry was used to address multiple pertinent clinical and methodological questions. Primary focus was on comparing different implant configurations (eg, glenosphere diameter) and surgical techniques (eg, latissimus dorsi transfer) to maximise functional recovery. Additionally, the cohort contributed to the determination of the clinical relevance and validity of radiological monitoring of cortical bone resorption and scapular notching. Finally, SAR data helped to demonstrate that returning to sports was among key patient expectations after reverse shoulder arthroplasty.
Future plans As first patients are approaching the 15 years follow-up landmark, the registry will continue providing essential data on long-term functional outcomes, implant stability, revision rates and aetiologies as well as patient satisfaction and quality-of-life. In addition to research and quality-control, the cohort data will be brought back to the patients by bolstering real-time clinical decision support.
- orthopaedic & trauma surgery
- orthopaedic sports trauma
- health informatics
- adult orthopaedics
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AM and H-KS contributed equally.
Contributors AM, LA and H-KS initiated the study and drafted the manuscript. CK, H-KS, BS and BWeber contributed with design, maintenance and data management. H-KS, CK, FM, MF, MG, CJ, BWirth, BWeber, BS, MS contributed with data. AM and LA analysed the data. All authors revised the manuscript and approved the final version to be published.
Funding This work was supported by the Wilhelm Schulthess Foundation and by the Schwyzer Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Ethical Committee of Canton Zürich (KEK-ZH-Nr. 2014-0483). All participants provided informed consent (see online supplemental files 1 and 2).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement External researchers are encouraged to pair with a collaboration partner within the Schulthess Klinik. A proposal is then submitted to the SAR steering committee that is ranked on clinical relevance, novelty, feasibility, methodological robustness and on whether that data request competes with an ongoing project at the Schulthess Klinik. Following an approval of a multi-centre collaboration by the cohort steering committee aggregated and/or anonymised data can be shared for the specified collaboration, contingent on approval by the cantonal ethical committee. For more information on collaboration please contact the corresponding author.
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