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 rates, and indications for shoulder arthroplasty, as well as estimates and indications for revision arthroplasty.

Methods: We used the Nationwide Inpatient Samples for 2009 through 2011 to calculate estimates of shoulder arthroplasty and assessed trends using Joinpoint (National Cancer Institute, Bethesda, MD) regression.

Results: The cumulative estimated utilization of primary shoulder arthroplasty (anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty) increased significantly from 52,397 procedures (95% confidence interval [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 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- to 84-year-old female subgroup (77 per 100,000 persons; 95% CI, 67-87). Revision cases comprised 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were because of mechanical complications/loosening whereas 18% were because of dislocation.

Conclusions: The utilization of primary shoulder arthroplasty significantly increased in just a 3-year time span, with a major contribution from reverse shoulder arthroplasty in 2011. Indications appear to have expanded because 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.

Keywords: Reverse shoulder arthroplasty; utilization.

Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Yearly Estimates of Primary Shoulder Arthroplasty* per 100,000 Persons in the United States by Age-Groups and Sex

Note: Green lines in the figure represent females and blue lines represent males *Shoulder arthroplasty includes anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty

Figure 2. Yearly Estimates of Revision Upper Extremity Arthroplasty per 100,000 Persons in the United States by Age-Groups and Sex

Note: Green lines in the figure represent females and blue lines represent males ≥85 age-group not included because there were

Figure 3. Select Indications for Revision Upper Extremity Arthroplasty in the United States (2009–11)

*prosthetic or peri-prosthetic Total does not equal 100% since only select indications included