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The Incidence of Shoulder Arthroplasty: Rise and Future Projections Compared to Hip and Knee Arthroplasty
Kevin Xavier Farley, BS1, Jacob M Wilson, MD2, Charles A Daly, MD1, Michael Brandon Gottschalk, MD1 and Eric R Wagner, MD, MS2, (1)Emory University, Atlanta, GA, (2)Emory University, Department of Orthopaedics, Atlanta, GA


The incidence of shoulder arthroplasty continues to rise. However, there remains a paucity of epidemiologic data in recent years. We aimed to examine the recent trends and predict future projections of hemiarthroplasty (HA), anatomic (aTSA), and reverse shoulder arthroplasty (RSA), as well as compare to the predictions for total hip (THA) and knee arthroplasty (TKA).



The National Inpatient Sample was queried from 2011 to 2016 for HA, aTSA, and RSA, as well as TKA and THA. The ICD-procedure code for RSA was not separated from the aTSA code prior to 2011, thus these years were excluded. Linear and Poisson regression was performed to project annual procedural incidence and volume to the year 2025. aTSA and RSA growth rates were compared to those of TKA and THA.



Between 2011 and 2016, the estimated number of primary shoulder arthroplasties performed increased by 91.1%. This was largely due to the exponential increase in RSA, which increased by 167.2% with an annual growth rate of 24.1% over the 6-year period. Linear regression analysis estimated the volume of shoulder arthroplasties to increase 91.9% by the year 2025, to an estimated 187,952 procedures. Poisson regression estimated annual shoulder arthroplasty procedural volume to increase 349% by 2025, an estimated 439,206 procedures. These estimates far outpace those of total hip and knee arthroplasty. The linear and Poisson models estimate that the volume of THAs performed in 2025 will increase by 57.8% and 92.1%, respectively. Additionally, the linear and Poisson models predict TKA to increase by 29.4% and 36.0%, respectively.


The projections for RSA and aTSA demonstrated substantial increases, with projected volume increases by the linear and Poisson models of 48.9% and 67.7% for aTSA (Figure 1) and 120.8% and 537.2% for RSA (Figure 2). Alternatively, HA was projected to decrease by 72.1%.


Discussion and Conclusion

The procedural volume and incidence of shoulder arthroplasty continues to rise at an exponential rate, corresponding with the increasing usage of the reverse prosthesis. The overall incidence is increasing at a greater rate than TKA or THA, with projections continuing to rise over the next decade. This exponential rise in primary TSA likely is associated with a rising demand for revision surgeries. Furthermore, these findings represent important considerations for policy-makers and administrators. In addition, this will lay a foundation for future investigations into resource allocation and cost-effectiveness.

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