Abstract
Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010–2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000–44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades.
Highlights
Introduction iationsWith the baby boomer generation reaching 65 years of age, the socioeconomic issues of an aging population, with higher incidences of degenerative joint diseases [1] and fractures, will certainly affect inpatient care
In contrast to hip and knee arthroplasty, the demand and impact of shoulder arthroplasty have been underestimated in the past, probably due to a smaller number of arthroplasties performed per year
The aim of this study was to provide a reliable projection of the future need for primary and revision shoulder arthroplasty to assist orthopedic surgeons, politicians, healthcare providers and other stakeholders in providing enough human and financial resources to maintain the current standard of care
Summary
Introduction iationsWith the baby boomer generation reaching 65 years of age, the socioeconomic issues of an aging population, with higher incidences of degenerative joint diseases [1] and fractures, will certainly affect inpatient care. While the increase in the number of hip and knee arthroplasties is predicted to slow down over the decades [2,3,4,5,6,7], only a few studies have examined national trends for upper extremity arthroplasties [8,9]. In contrast to hip and knee arthroplasty, the demand and impact of shoulder arthroplasty have been underestimated in the past, probably due to a smaller number of arthroplasties performed per year. In the United States, which is commonly used as a reference in other orthopedic studies, current growth rates for shoulder arthroplasties are reported to be comparable with, or even higher than the growth rates for total hip and knee procedures [8,10]. The projected demand for shoulder arthroplasty is Licensee MDPI, Basel, Switzerland.
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