Session 15: Shoulder / Elbow
Fredag d. 26. oktober
11:00-12:00
Lokale: Reykjavik
Chairmen: Lars Henrik Frich og Thomas Falstie Jensen
Per Hviid Gundtoft, Mikkel Lindegaard Attrup, Anne Krog Kristensen, Jette Wessel Vobbe, Per Hölmich, Lilli Sørensen
Ortopedic Department, Kolding Sygehus; Sports Orthopaedic Research Centre-Copenhagen , Copenhagen University Hospital Amager-Hvidovre; Orthopedic Department, Vejle Hospital; Orthopedic Department, Vejle Hospital; Sports Orthopaedic Research Centre-Copenhagen , Copenhagen University Hospital Amager-Hvidovre ; Orthopedic Department, Vejle Hospital
Background: Patients with diabetes mellitus are often referred to as having a worse prognosis of a frozen shoulder, but the evidence for this statement is non-existent.
Purpose / Aim of Study: To study if diabetes mellitus affects the severity of a frozen shoulder prognosis.
Materials and Methods: In this 2-year follow-up study patients from three participating hospitals with newly diagnosed frozen shoulder were consecutively included and asked to fill out a questionnaire: at time of diagnosis and at 6-, 12- and 24-months follow- up. The questionnaire included the Oxford Shoulder Score (OSS) and the Visual Analogue Scale (VAS) for both maximum and average daily pain. Furthermore, patients were asked to report on whether arthroscopic release had been performed. Diabetes mellitus status was recorded for all patients, and patients not previously diagnosed with diabetes mellitus were invited to be tested with the HbA1c test.
Findings / Results: A total of 235 patients were included, of which 34 were previously diagnosed with frozen shoulder. Patients with diabetes mellitus had similar OSS (p=0.22) and VAS score for maximum (p=0.46) and average (p=0.46) daily pain at time of diagnosis compared to patients without diabetes mellitus. Both groups improved in OSS and VAS score, but patients with diabetes mellitus had a worse OSS at 6- (p=0.04), and 24-months follow- up (p=0.02); worse VAS score for maximum daily pain at 6- (p=0.04), 12- (p=0.03) and 24-months follow-up (p=0.03); and worse VAS score for average daily pain at 6- (p=0.02), and 12-months follow-up (p=0.01) Patients with diabetes mellitus had an increased probability of undergoing arthroscopic release (p<0.05).
Conclusions: Diabetes mellitus is associated with a worse prognosis in patients with frozen shoulder, but all patients can expect gradual improvement during the 2 years following their diagnosis.
Ortopedic Department, Kolding Sygehus; Sports Orthopaedic Research Centre-Copenhagen , Copenhagen University Hospital Amager-Hvidovre; Orthopedic Department, Vejle Hospital; Orthopedic Department, Vejle Hospital; Sports Orthopaedic Research Centre-Copenhagen , Copenhagen University Hospital Amager-Hvidovre ; Orthopedic Department, Vejle Hospital
Background: Patients with diabetes mellitus are often referred to as having a worse prognosis of a frozen shoulder, but the evidence for this statement is non-existent.
Purpose / Aim of Study: To study if diabetes mellitus affects the severity of a frozen shoulder prognosis.
Materials and Methods: In this 2-year follow-up study patients from three participating hospitals with newly diagnosed frozen shoulder were consecutively included and asked to fill out a questionnaire: at time of diagnosis and at 6-, 12- and 24-months follow- up. The questionnaire included the Oxford Shoulder Score (OSS) and the Visual Analogue Scale (VAS) for both maximum and average daily pain. Furthermore, patients were asked to report on whether arthroscopic release had been performed. Diabetes mellitus status was recorded for all patients, and patients not previously diagnosed with diabetes mellitus were invited to be tested with the HbA1c test.
Findings / Results: A total of 235 patients were included, of which 34 were previously diagnosed with frozen shoulder. Patients with diabetes mellitus had similar OSS (p=0.22) and VAS score for maximum (p=0.46) and average (p=0.46) daily pain at time of diagnosis compared to patients without diabetes mellitus. Both groups improved in OSS and VAS score, but patients with diabetes mellitus had a worse OSS at 6- (p=0.04), and 24-months follow- up (p=0.02); worse VAS score for maximum daily pain at 6- (p=0.04), 12- (p=0.03) and 24-months follow-up (p=0.03); and worse VAS score for average daily pain at 6- (p=0.02), and 12-months follow-up (p=0.01) Patients with diabetes mellitus had an increased probability of undergoing arthroscopic release (p<0.05).
Conclusions: Diabetes mellitus is associated with a worse prognosis in patients with frozen shoulder, but all patients can expect gradual improvement during the 2 years following their diagnosis.
Linus Daniel Leonhard Duchstein, Lars Friberg, Lene Rørdam, Line Marker, Mads Okholm, Michael Rindom Krogsgaard
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital
Background: Frozen shoulder is characterized by pain and reduced mobility of the shoulder caused by inflammatory contracture of the joint capsule leading. Clinical diagnosis is based on movement restriction, but in the first phase of the condition motion can be normal and the condition can be interpreted as impingement syndrome, which does not involve the shoulder capsule and which is treated differently.
Purpose / Aim of Study: Since inflammation/increased tissue turnover is present in frozen shoulder we aimed to study whether 18F-FDG accumulation in the joint during a PET/CT scan could distinguish frozen shoulder from impingement.
Materials and Methods: Ten consecutive patients with frozen shoulder and 10 with subacromial impingement scheduled for arthroscopic treatment underwent F18- FDG PET/CT before surgery (200MBq, 1h rest). PET/CT slides were evaluated visually by 2 experienced nuclear medicine physicians and quantitatively by defining regions of interest (ROI) around both shoulders and analyzing the standard uptake values (SUV). The other shoulder was used for normalization. All analyses very done blinded to patient group.
Findings / Results: Patients with frozen shoulder show increased SUV uptake evaluated visually and by ROI analysis. The kappa-value for the visual evaluation was 0.74. There was a sensitivity of 85% and specificity of 93% for physicians evaluation and 77% sensitivity and 96% specificity for the quantitative analysis. Combining these two methods sensitivity was 100% sensitivity and specificity 92%.
Conclusions: 18F-FDG PET/CT is a sensitive and non-invasive method to diagnose frozen shoulder and distinguish it from subacromial impingement. This method is relevant in cases where there is doubt about the diagnosis frozen shoulder.
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital
Background: Frozen shoulder is characterized by pain and reduced mobility of the shoulder caused by inflammatory contracture of the joint capsule leading. Clinical diagnosis is based on movement restriction, but in the first phase of the condition motion can be normal and the condition can be interpreted as impingement syndrome, which does not involve the shoulder capsule and which is treated differently.
Purpose / Aim of Study: Since inflammation/increased tissue turnover is present in frozen shoulder we aimed to study whether 18F-FDG accumulation in the joint during a PET/CT scan could distinguish frozen shoulder from impingement.
Materials and Methods: Ten consecutive patients with frozen shoulder and 10 with subacromial impingement scheduled for arthroscopic treatment underwent F18- FDG PET/CT before surgery (200MBq, 1h rest). PET/CT slides were evaluated visually by 2 experienced nuclear medicine physicians and quantitatively by defining regions of interest (ROI) around both shoulders and analyzing the standard uptake values (SUV). The other shoulder was used for normalization. All analyses very done blinded to patient group.
Findings / Results: Patients with frozen shoulder show increased SUV uptake evaluated visually and by ROI analysis. The kappa-value for the visual evaluation was 0.74. There was a sensitivity of 85% and specificity of 93% for physicians evaluation and 77% sensitivity and 96% specificity for the quantitative analysis. Combining these two methods sensitivity was 100% sensitivity and specificity 92%.
Conclusions: 18F-FDG PET/CT is a sensitive and non-invasive method to diagnose frozen shoulder and distinguish it from subacromial impingement. This method is relevant in cases where there is doubt about the diagnosis frozen shoulder.
Elisabeth Bright, Sebastian Breddam Mosegaard, Torben Bæk Hansen, Thomas Klebe, Michael Toft Væsel, Inger Mechlenburg, Maiken Stilling
Department of Orthopaedic Surgery, Aalborg University Hospital; University clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro; University clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro; Section for Shoulder and Elbow Surgery , Center for Planned Surgery, Regional Hospital Silkeborg; Department of Orthopaedic Surgery, Regional Hospital Viborg; Orthopaedic Research Unit, Department of Clinical Medicine , Aarhus University Hospital; Department of Orthopaedics; Department of Clinical Medicine, Aarhus University Hospital
Background: Osteoporosis is often present in displaced proximal humeral fractures and challenges joint preserving surgery. Little is known of functional outcome in relation to osteoporosis and stress shielding after surgery with an angle stable locking plate (ASLP).
Purpose / Aim of Study: To investigate bone mineral density (BMD) changes in the proximal humerus (PH) and functional outcomes 1 year after fractures treated with ASLP.
Materials and Methods: 36 patients (29 female) at mean 66 years (range 38-83) with unilateral 3-4-part PH fractures were included in a prospective multicenter study. Patients were operated with Winsta ASLP (Fischer-Medical). A 1 year follow-up included repeated measurements of shoulder BMD (primary outcome). Function was measured with Constant Score (CS) and the Western Ontario Osteoarthritis of the Shoulder index (WOOS), quality of life with the Short Form 36 (SF-36), and pain was reported by VAS. The effect of T-scores above and below the osteoporosis limit (-2.4) was investigated.
Findings / Results: At 1 year, the %-change in BMD was higher in the operated (-18%) versus healthy (-6%) PH in all patients (p=0.01). 17 (47.2%) patients had a T-score below -2.4, but T-scores had no measurable effect on functional outcomes. From 3 to 12 months the SF-36 physical component score decreased (p=0.02) and increased in pain (p=0.03), while the CS increased 11.71 points, 95% CI [8.51–14.92]. VAS pain and WOOS were similar pre-injury and at 1 year follow-up (p=0.17).
Conclusions: 1 year after plating of dislocated proximal humerus fractures BMD measurements showed stress shielding in the proximal humerus. No significant difference in pain and shoulder function was found pre-injury compared to 1 year post-operatively, but the general function (SF-36) decreased. Osteoporosis status did not affect outcomes.
Department of Orthopaedic Surgery, Aalborg University Hospital; University clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro; University clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro; Section for Shoulder and Elbow Surgery , Center for Planned Surgery, Regional Hospital Silkeborg; Department of Orthopaedic Surgery, Regional Hospital Viborg; Orthopaedic Research Unit, Department of Clinical Medicine , Aarhus University Hospital; Department of Orthopaedics; Department of Clinical Medicine, Aarhus University Hospital
Background: Osteoporosis is often present in displaced proximal humeral fractures and challenges joint preserving surgery. Little is known of functional outcome in relation to osteoporosis and stress shielding after surgery with an angle stable locking plate (ASLP).
Purpose / Aim of Study: To investigate bone mineral density (BMD) changes in the proximal humerus (PH) and functional outcomes 1 year after fractures treated with ASLP.
Materials and Methods: 36 patients (29 female) at mean 66 years (range 38-83) with unilateral 3-4-part PH fractures were included in a prospective multicenter study. Patients were operated with Winsta ASLP (Fischer-Medical). A 1 year follow-up included repeated measurements of shoulder BMD (primary outcome). Function was measured with Constant Score (CS) and the Western Ontario Osteoarthritis of the Shoulder index (WOOS), quality of life with the Short Form 36 (SF-36), and pain was reported by VAS. The effect of T-scores above and below the osteoporosis limit (-2.4) was investigated.
Findings / Results: At 1 year, the %-change in BMD was higher in the operated (-18%) versus healthy (-6%) PH in all patients (p=0.01). 17 (47.2%) patients had a T-score below -2.4, but T-scores had no measurable effect on functional outcomes. From 3 to 12 months the SF-36 physical component score decreased (p=0.02) and increased in pain (p=0.03), while the CS increased 11.71 points, 95% CI [8.51–14.92]. VAS pain and WOOS were similar pre-injury and at 1 year follow-up (p=0.17).
Conclusions: 1 year after plating of dislocated proximal humerus fractures BMD measurements showed stress shielding in the proximal humerus. No significant difference in pain and shoulder function was found pre-injury compared to 1 year post-operatively, but the general function (SF-36) decreased. Osteoporosis status did not affect outcomes.
Ditte Unbehaun, Sigrid Rasmussen, Inger Mechlenburg, Jeppe Vejlgaard Rasmussen
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital
Background: There is no consensus on the optimal treatment of proximal humerus fracture (PHF) sequelae.
Purpose / Aim of Study: The primary aim of this study was to report the revision rate of shoulder arthroplasty for PHF sequelae and to report the reasons for revision. The secondary aim was to determine the revision rate for stemmed hemiarthroplasty (SHA) and reverse shoulder arthroplasty (RSA).
Materials and Methods: Data was derived from the Nordic Arthroplasty Register Association. Kaplan-Meier was used to illustrate the 10-year survival rates. Cox regression model was used to calculate hazard ratios. Age categories, gender, period of surgery and arthroplasty type were included in the model.
Findings / Results: 19,857 primary arthroplasties were reported from 2004 to 2013, of which 1,563 (8%) were operated due to PHF sequelae. 175 (11.2%) arthroplasties were revised. The most common reasons for revision were luxation/instability (3.9%), others, which include glenoid wear (2.4%) and infection (1.7%). The cumulative arthroplasty survival rate was significantly higher for SHA compared to RSA (p=0.006). The cumulative arthroplasty survival rates after 1, 5 and 10 year were 0.96, 0.89 and 0.86 for SHA and 0.89, 0.85 and 0.85 for RSA. The adjusted hazard ratio of revision of RSA relative to SHA was 1.73 (CI: 1.23;2.45). The cumulative arthroplasty survival rate was significantly higher for female patients compared to male patients (p<0.001). The cumulative arthroplasty survival rates after 1, 5 and 10 year were 0.95, 0.89 and 0.87 for female patients and 0.91, 0.82 and 0.75 for male patients. The adjusted hazard ratio of revision of male patients relative to female patients was 1.80 (CI: 1.27;2.55).
Conclusions: Patients treated with RSA compared to patients treated with SHA and male patients compared to female patients had an increased risk of revision.
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital
Background: There is no consensus on the optimal treatment of proximal humerus fracture (PHF) sequelae.
Purpose / Aim of Study: The primary aim of this study was to report the revision rate of shoulder arthroplasty for PHF sequelae and to report the reasons for revision. The secondary aim was to determine the revision rate for stemmed hemiarthroplasty (SHA) and reverse shoulder arthroplasty (RSA).
Materials and Methods: Data was derived from the Nordic Arthroplasty Register Association. Kaplan-Meier was used to illustrate the 10-year survival rates. Cox regression model was used to calculate hazard ratios. Age categories, gender, period of surgery and arthroplasty type were included in the model.
Findings / Results: 19,857 primary arthroplasties were reported from 2004 to 2013, of which 1,563 (8%) were operated due to PHF sequelae. 175 (11.2%) arthroplasties were revised. The most common reasons for revision were luxation/instability (3.9%), others, which include glenoid wear (2.4%) and infection (1.7%). The cumulative arthroplasty survival rate was significantly higher for SHA compared to RSA (p=0.006). The cumulative arthroplasty survival rates after 1, 5 and 10 year were 0.96, 0.89 and 0.86 for SHA and 0.89, 0.85 and 0.85 for RSA. The adjusted hazard ratio of revision of RSA relative to SHA was 1.73 (CI: 1.23;2.45). The cumulative arthroplasty survival rate was significantly higher for female patients compared to male patients (p<0.001). The cumulative arthroplasty survival rates after 1, 5 and 10 year were 0.95, 0.89 and 0.87 for female patients and 0.91, 0.82 and 0.75 for male patients. The adjusted hazard ratio of revision of male patients relative to female patients was 1.80 (CI: 1.27;2.55).
Conclusions: Patients treated with RSA compared to patients treated with SHA and male patients compared to female patients had an increased risk of revision.
Sigrid Rasmussen, Ditte Unbehaun, Inger Mechlenburg, Alexander Amundsen, Jeppe Vejlgaard Rasmussen
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital
Background: Fracture sequelae is challenging to treat in shoulder reconstruction.
Purpose / Aim of Study: The purpose of this study was to investigate risk factors for revision and patient-reported outcome after treatment with shoulder arthroplasty for previously non-operatively treated proximal humerus fracture sequelae.
Materials and Methods: Data from the Danish Shoulder Arthroplasty Registry included 837 shoulder arthroplasties performed for fracture sequelae between 2006 and 2015. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome at one year. Type of arthroplasty, gender, age, indication of treatment and period of surgery was investigated as risk factors. Cox regression and linear regression were used in the statistical analyses.
Findings / Results: 644 patients treated with stemmed hemiarthroplasty (SHA) and 127 patients treated with reverse shoulder arthroplasty (RSA) were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RSA were revised. Men treated with RSA had a significant higher revision rate (HR=3.81, 95%CI: 1.12; 12.93, p=0.03) than men treated with SHA. 454 (54%) of the patients returned a complete WOOS. The mean WOOS-score was 47.4 for SHA and 47.5 for RSA. Patients older than 65 years had a significant lower WOOS-score (mean difference=-6.64, 95%CI:-12.24;-1.04, p=0.02) than patients younger than 65 years.
Conclusions: Shoulder arthroplasty for fracture sequelae is associated with a poor patient-reported outcome and a high risk of revision. Especially men treated with RSA had a high risk of revision. Older patients had a statistically significant lower WOOS-score compared to elderly patients, but the difference did not exceed the minimal clinically important difference.
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital; Department of Orthopaedic Surgery, Herlev University Hospital
Background: Fracture sequelae is challenging to treat in shoulder reconstruction.
Purpose / Aim of Study: The purpose of this study was to investigate risk factors for revision and patient-reported outcome after treatment with shoulder arthroplasty for previously non-operatively treated proximal humerus fracture sequelae.
Materials and Methods: Data from the Danish Shoulder Arthroplasty Registry included 837 shoulder arthroplasties performed for fracture sequelae between 2006 and 2015. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome at one year. Type of arthroplasty, gender, age, indication of treatment and period of surgery was investigated as risk factors. Cox regression and linear regression were used in the statistical analyses.
Findings / Results: 644 patients treated with stemmed hemiarthroplasty (SHA) and 127 patients treated with reverse shoulder arthroplasty (RSA) were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RSA were revised. Men treated with RSA had a significant higher revision rate (HR=3.81, 95%CI: 1.12; 12.93, p=0.03) than men treated with SHA. 454 (54%) of the patients returned a complete WOOS. The mean WOOS-score was 47.4 for SHA and 47.5 for RSA. Patients older than 65 years had a significant lower WOOS-score (mean difference=-6.64, 95%CI:-12.24;-1.04, p=0.02) than patients younger than 65 years.
Conclusions: Shoulder arthroplasty for fracture sequelae is associated with a poor patient-reported outcome and a high risk of revision. Especially men treated with RSA had a high risk of revision. Older patients had a statistically significant lower WOOS-score compared to elderly patients, but the difference did not exceed the minimal clinically important difference.
Anne-Kathrine Rosenkrans Sørensen, Lianna Hede Hammeken, Andreas Haubjerg Qvist, Steen Lund Jensen, Lars Ehlers
Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University; Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University
Background: Conventional treatment of displaced midshaft clavicular fractures is nonoperative. Recent studies have implied that operative treatment might result in a faster return to work, resulting in a decreased productivity loss for society. The cost-utility of operative versus nonoperative treatment has not previously been investigated utilizing a societal perspective.
Purpose / Aim of Study: To assess the cost-utility of plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures in Danish adults.
Materials and Methods: Decision analytic modelling of incremental costs and quality adjusted life years (QALYs) was applied. Data was primarily retrieved from a recent Danish randomized controlled trial (RCT), published RCT’s and field observation. A one-year time horizon was applied and prices reported in 2016-level. A health sector and a societal perspective were applied.
Findings / Results: Operative treatment is associated with a larger gain in QALYs and a higher cost compared to nonoperative treatment. The incremental cost effectiveness ratio (ICER) was estimated to DKK 1,273,455 per QALY from a health sector perspective and DKK 1,241,364 per QALY from a societal perspective. Considering a subgroup of patients with a high-load shoulder profession, operative treatment result in a lower gain in QALYs and a higher cost compared to nonoperative treatment from a health sector perspective. Considering a societal perspective, the ICER was estimated to DKK -1,100,927 per reduction of one QALY. Sensitivity analyses showed that all results were subject to uncertainty.
Conclusions: Operative treatment is not cost- effective considering a threshold of £30,000 (≈ DKK 267,600) per QALY as reported by NICE. However, for patients with a high-load shoulder profession, operative treatment might be cost-effective considering productivity costs.
Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University; Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University
Background: Conventional treatment of displaced midshaft clavicular fractures is nonoperative. Recent studies have implied that operative treatment might result in a faster return to work, resulting in a decreased productivity loss for society. The cost-utility of operative versus nonoperative treatment has not previously been investigated utilizing a societal perspective.
Purpose / Aim of Study: To assess the cost-utility of plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures in Danish adults.
Materials and Methods: Decision analytic modelling of incremental costs and quality adjusted life years (QALYs) was applied. Data was primarily retrieved from a recent Danish randomized controlled trial (RCT), published RCT’s and field observation. A one-year time horizon was applied and prices reported in 2016-level. A health sector and a societal perspective were applied.
Findings / Results: Operative treatment is associated with a larger gain in QALYs and a higher cost compared to nonoperative treatment. The incremental cost effectiveness ratio (ICER) was estimated to DKK 1,273,455 per QALY from a health sector perspective and DKK 1,241,364 per QALY from a societal perspective. Considering a subgroup of patients with a high-load shoulder profession, operative treatment result in a lower gain in QALYs and a higher cost compared to nonoperative treatment from a health sector perspective. Considering a societal perspective, the ICER was estimated to DKK -1,100,927 per reduction of one QALY. Sensitivity analyses showed that all results were subject to uncertainty.
Conclusions: Operative treatment is not cost- effective considering a threshold of £30,000 (≈ DKK 267,600) per QALY as reported by NICE. However, for patients with a high-load shoulder profession, operative treatment might be cost-effective considering productivity costs.
Ahmed Halloum, Haubjerg Qvist Andreas, Rasmeussen Deutch Søren
Ortopædkirurgisk afd., Regionshospitalet Viborg; Ortopædkirurgisk afd., Aalborg Universitetshospital; Ortopædkirurgisk afd., Regionshospitalet Rander
Background: In 2013, the Danish Health Authority released national guidelines describing the treatment of impingement patients in the primary sector, along with guidelines for specialist referral. Despite this, we see a growing number of patients referred without initial relevant treatment in the primary sector.
Purpose / Aim of Study: To improve the quality of treatment in the primary sector by informing the general practitioners (GP) about the existence of the national guidelines.
Materials and Methods: We conducted a pre and post interventional study. In April 2017 a letter was sent to all GPs in our service area informing about the National treatment Guidelines. In the period of September to November 2016 and June to November 2017 journals were reviewed to determine the quality of treatment in primary care. Patients were divided into three groups of three months: Pre-intervention (PI), early post intervention (EPI) and late post intervention (LPI). Relevant primary care treatment was defined as minimum three months of relevant physiotherapy and corticosteroid treatment. Treatment in the outpatient clinic was used as a surrogate marker for the quality of treatment in primary care.
Findings / Results: 260 patients (135 F, 125 M) with at mean age of 56 years were included in the study. In the PI group 22 patients (20 %) were offered surgery versus 20 patients (33 %) in the EPI group and 20 patients (22 %) in the LPI group. There was no significant difference before and after our intervention (PI vs. EPI: p=0,068 and PI vs. LPI: p=0,73)
Conclusions: Our intervention did not improve the quality of treatment of impingement patients in the primary sector. Raising awareness of the National Guidelines is difficult on a single hospital level, and may require national effort.
Ortopædkirurgisk afd., Regionshospitalet Viborg; Ortopædkirurgisk afd., Aalborg Universitetshospital; Ortopædkirurgisk afd., Regionshospitalet Rander
Background: In 2013, the Danish Health Authority released national guidelines describing the treatment of impingement patients in the primary sector, along with guidelines for specialist referral. Despite this, we see a growing number of patients referred without initial relevant treatment in the primary sector.
Purpose / Aim of Study: To improve the quality of treatment in the primary sector by informing the general practitioners (GP) about the existence of the national guidelines.
Materials and Methods: We conducted a pre and post interventional study. In April 2017 a letter was sent to all GPs in our service area informing about the National treatment Guidelines. In the period of September to November 2016 and June to November 2017 journals were reviewed to determine the quality of treatment in primary care. Patients were divided into three groups of three months: Pre-intervention (PI), early post intervention (EPI) and late post intervention (LPI). Relevant primary care treatment was defined as minimum three months of relevant physiotherapy and corticosteroid treatment. Treatment in the outpatient clinic was used as a surrogate marker for the quality of treatment in primary care.
Findings / Results: 260 patients (135 F, 125 M) with at mean age of 56 years were included in the study. In the PI group 22 patients (20 %) were offered surgery versus 20 patients (33 %) in the EPI group and 20 patients (22 %) in the LPI group. There was no significant difference before and after our intervention (PI vs. EPI: p=0,068 and PI vs. LPI: p=0,73)
Conclusions: Our intervention did not improve the quality of treatment of impingement patients in the primary sector. Raising awareness of the National Guidelines is difficult on a single hospital level, and may require national effort.