The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty

Abstract

Background We assessed the contribution of reverse shoulder arthroplasty to overall utilization of primary shoulder arthroplasty, and present age and sex stratified national rates of shoulder arthroplasty. We also assessed contemporary complication rates, mortality, and indications for shoulder arthroplasty, as well as estimates and indications for revision arthroplasty. Methods We used the Nationwide Inpatient Samples for 2009–2011 to calculate estimates of shoulder arthroplasty and assessed trends using joinpoint regression. Results The cumulative estimated utilization of primary shoulder arthroplasty (total anatomical, hemi, and reverse) increased significantly from 52,397 procedures (95% CI=47,093–57,701) in 2009 to 67,184 cases (95% CI=60,638–73,731) in 2011. Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The diagnosis of concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases. The highest rate of reverse shoulder arthroplasty was in the 75–84 year female sub-group (77; 95% CI=67–87). Revision cases were 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were secondary to mechanical complications/loosening while 18% were due to dislocation. Conclusions The utilization of primary shoulder arthroplasty significantly increased in just a three year time span, with a major contribution from reverse shoulder arthroplasty in 2011. Indications appear to have expanded as a large percentage of patients did not have rotator cuff pathology. The burden from revision arthroplasties was also substantial and efforts to optimize outcomes and longevity of primary shoulder arthroplasty are needed. Level of evidence Epidemiology Study, Database Analysis

Yearly Trends in Elective Shoulder Arthroplasty, 2005–2013

“…This group was followed closely by women ages 75–84 years. Our findings accord with those of Jain and Yamaguchi , who used the US National Inpatient Sample and found that the hightest rates of shoulder arthroplasty utilization were in women ages 75–84 years, followed by those ages 65–74 years. We also found a 9% yearly increase in the incidence of all shoulder arthroplasties in men ages 45–54 years.…”

“…The increase in the utilization of shoulder arthroplasty observed is consistent with studies of other cohorts . Kim et al noted a 2.5‐fold increase in shoulder arthroplasty between 1998 and 2008 utilizing the US Nationwide Inpatient Sample.…”

“…Shoulder arthroplasty has been increasingly utilized in the US over the past several decades . This trend will likely continue , and some have projected that the growth in demand for shoulder athroplasty may exceed that of hip and knee arthroplasty in the future .…”

Shoulder Arthroplasty Outcomes After Prior Non-Arthroplasty Shoulder Surgery

“…There is a growing trend in the utilization of both total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RTSA) 1-5 . For the vast majority of patients, shoulder arthroplasty is associated with a predictably good or excellent clinical outcome and a relatively low complication rate 6-8 .…”

Validation of In Vivo Linear and Volumetric Wear Measurement for Reverse Total Shoulder Arthroplasty Using Model‐Based Radiostereometric Analysis

“…Though RSA has been used in a number of studies investigating wear in both the hip and knee, in vivo wear measurements remain incomplete for the shoulder . As the number of total shoulder procedures is expected to grow exponentially within the next decade, it is important to evaluate how new designs and bearing materials interact . Of particular interest is reverse total shoulder arthroplasty (rTSA), which features a semi‐constrained design and ultra‐high molecular weight PE .…”