Volume, indications, and number of surgeons performing reverse total shoulder arthroplasty continue to expand: a nationwide cohort analysis from 2016-2020

Abstract

Since its approval, reverse total shoulder arthroplasty (rTSA) has continued to increase in usage, with expanding indications beyond rotator cuff arthropathy. Existing literature has captured further increased utilization over the last decade through 2017. However, this data has not been updated to include a contemporary cohort of patients. This study sought to determine the trends of anatomic total shoulder arthroplasty (aTSA), rTSA, and hemiarthroplasty (HA) usage based on primary diagnosis and total number of surgeons performing each procedure annually from 2016-2020. Patients who underwent primary rTSA, aTSA, and HA from 2016-2020 were identified in the Premier Healthcare Database. Primary indication diagnoses for procedures were identified using International Classification of Diseases 10th edition codes. Temporal trends in patient and hospital demographics, primary indication, and procedure utilization were captured on an annualized basis. The number of surgeons performing each procedure annually was noted. Descriptive statistics were employed with significance set at P<.05. From 2016 to 2020, 154,499 patients undergoing primary shoulder arthroplasty were identified: 48,890 aTSA, 95,808 rTSA, and 9801 HA. In 2016, rTSA comprised a slight majority (55%) of all arthroplasty cases but increased to nearly 70% of all arthroplasty cases in 2020. The absolute numbers of aTSA and HA cases decreased over time, while rTSA volume increased from 14,781 in 2016 to a high of 23,644 cases in 2019. There was a corresponding 12% increase in the number of surgeons performing rTSA across the same time period, contrasted with a 42.1% decrease in surgeons performing HA and a 14.3% decrease for aTSA. Glenohumeral osteoarthritis remains the most common indication for rTSA and aTSA, while HA is used primarily for proximal humerus fractures or hardware complications. The volume of primary rTSA in the United States has continued to increase from 2016 to 2020 with concurrent decreases in the number of primary aTSA and HA cases performed. Primary rTSA accounts for nearly 70% of all primary shoulder arthroplasty cases. The number of surgeons performing rTSA continues to increase, while there has been a decrease in the number of surgeons performing aTSA and HA.