Utilization of shoulder arthroplasty in the United States – An analysis of current trends and future predictions

Abstract Background Shoulder arthroplasty is an increasingly popular treatment option for various shoulder pathologies. The purpose of this study is to evaluate changes in the national demand for shoulder arthroplasty, both anatomic (aTSA) and reverse (rTSA), in the United States and to predict future trends in utilization. Methods National Inpatient Sample (NIS) data was queried through the Healthcare Cost and Utilization Project for ICD-9-CM and ICD-10-PCS codes for aTSA and rTSA between 1997 and 2016. The total number of inpatient stays for each year was broken down by gender, age group and the type of prosthesis (aTSA or rTSA). Population data from the United States Census Bureau, stratified by age and gender, were used to generate future population estimates. A linear regression model was created to project future demand for shoulder arthroplasty based on predicted changes in both population and historic trends in utilization. Cost data was used to estimate the total cost of TSAs in the United States. Results The number of combined aTSA and rTSA cases reported in the NIS data has increased from 6,653 in 1997 to 97,995 in 2016, demonstrating a 1,373% increase. Our model predicts that overall shoulder arthroplasty utilization will increase 122% by 2040, while aTSA and rTSA will increase 49% and 122%, respectively by 2025. Utilization of rTSA is projected to be higher than aTSA across all age groups. In ages greater than 84, aTSA utilization is projected to decrease by 20% while rTSA is projected to increase by 120%. Similar growth rates are expected for males and females. The cost analysis estimated that the total cost of TSAs will reach $4 billion by 2030. Conclusion This study demonstrates a projected sustained increase in the demand for shoulder arthroplasty over the next 20 years, with a 122% increase by 2040 due mainly to increased utilization of rTSA. The demand for rTSA is growing at a faster rate and annual utilization has surpassed aTSA. The anticipated increase represents a potentially significant financial burden on the US healthcare system. Level of Evidence IV