Establishing an international shoulder arthroplasty consortium.

Shoulder replacement surgery has evolved dramatically since first attempted by P ean and Gluck and modernized by Neer. Interest in shoulder replacement surgery is growing globally and, in many countries, is the fastest growing market in joint arthroplasty surgery. In the coming year, over 57,000 replacements will be undertaken in the United States and over 4,000 in Australia. To a large extent, this growth is based on successful outcomes with patients benefiting from carefully executed surgery, using implants with established track records. However, with arthroplasty surgery of any joint, problems may be slow to become clinically apparent and long follow-up is required. Inevitably, with increases in shoulder replacement rates, the future revision burden will increase as well. In addition, often large patient volumes are needed to detect differences in outcomes, which may be beyond the scope of clinical trials. Internationally, joint arthroplasty registries are becoming increasingly recognized as important mechanisms for monitoring patient and prosthesis outcomes, providing large data sets that give an early indication when patient groups or implants are not functioning as expected. The ability to provide guidance and reduce revision burden in this current climate of increased scrutiny on health care expenditure has significant attraction. This level of monitoring requires informed clinician oversight to be relevant and interpreted appropriately. International interest in collaborative arrangements among joint registries already exists in the sphere of hip and knee arthroplasty with the formation of the International Society of Arthroplasty Registries (ISAR) and a collaborative data-sharing arrangement sponsored by the Food and Drug Administration with the International Consortium of Outcome Registries (ICOR). This environment of high-level data sharing greatly increases the potential insights and level of understanding into causes for revision. There are already a small number of national-level shoulder registries internationally, with the longest