Trends in total shoulder arthroplasty utilization and implant pricing

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2024-09-23 DOI:10.1053/j.sart.2024.08.003

Gabrielle Dykhouse BS , Anthony Finocchiaro BS , Carl M. Cirino MD , Ashwin Mahesh BS , Lawrence V. Gulotta MD , Joshua S. Dines MD , Michael C. Fu MD, MHS

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引用次数: 0

Abstract

Background

Total shoulder arthroplasty (TSA) is the third most common total joint replacement procedure in the United States, with high rates of success and cost-effectiveness. As indications continue to expand, anatomic TSA (aTSA), reverse shoulder arthroplasty (RSA), and hemiarthroplasty are available procedures for treating patients with varying end-stage shoulder pathologies. While previous studies have documented trends in overall costs and reimbursements in TSA, there is limited information regarding recent trends in implant utilization, pricing, and procedure type. Therefore, this study aimed to analyze trends in implant and technology utilization for TSA in the United States between 2013 and 2022 to inform decision-making and improve clinical best practices.

Methods

Utilization trends and average implant prices between 2013 and 2022 were extracted from Orthopedic Network News, the largest publicly available implant registry. All costs and prices were adjusted for inflation. Trends were analyzed using linear regressions.

Results

Averages and nationwide estimates for 2022 were based off 7339 shoulder cases from 117 US hospitals. RSA significantly increased from 40% in 2013 to 72% of all shoulder arthroplasties in 2022 (β = 4.18; P < .001), whereas aTSA significantly decreased from 43% to 20% (β = −0.34; P < .001), and hemiarthroplasty significantly decreased from 10% to 1% (β = −1.07; P < .001). Other types of procedures, such as revisions and shoulder resurfacings, constituted 7%. Anatomic constructs showed a rise in stemless humeral component usage from 2% in 2017 to 10% in 2022 (β = 1.4; P < .01). Financially, Medicare physician payment for shoulder surgeries witnessed significant decline from $1882 USD in 2017 to $1428 in 2023 (β = −73; P < .001). The inflation-adjusted cost of aTSA also decreased from $8055 in 2013 to $6223 in 2022 (β = −173.56; P < .01), and RSA from $12,207 to $8882 in 2022 (β = −318.31; P < .001).

Conclusion

Trends in primary TSA procedures feature a growing prevalence of RSA as compared to aTSA, in addition to a rise in stemless humeral implants within aTSA. As both Medicare physician reimbursements and implant prices continue to decrease, it is important for surgeons to consider the tradeoffs of different implant materials and patient-specific technology when performing such procedures.

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全肩关节置换术应用和假体定价的趋势

背景：全肩关节置换术（TSA）是美国第三大最常见的全关节置换术，具有很高的成功率和成本效益。随着适应症的不断扩大，解剖性TSA （aTSA）、反向肩关节置换术（RSA）和半关节置换术是治疗不同终末期肩关节病变患者的有效方法。虽然以前的研究已经记录了TSA的总体成本和报销趋势，但关于植入物使用、定价和手术类型的最新趋势的信息有限。因此，本研究旨在分析2013年至2022年美国TSA植入物和技术使用的趋势，为决策提供信息并改进临床最佳实践。方法从最大的公开种植体注册网站骨科网络新闻（Orthopedic Network News）中提取2013年至2022年的使用趋势和平均种植体价格。所有的成本和价格都根据通货膨胀进行了调整。采用线性回归分析趋势。结果：2022年的平均值和全国估计是基于美国117家医院的7339例肩部病例。RSA在所有肩关节置换术中的比例从2013年的40%显著增加到2022年的72% (β = 4.18；P & lt;.001)，而aTSA从43%显著降低到20% (β = - 0.34；P & lt;.001)，半关节置换术从10%显著降低到1% (β = - 1.07；P & lt;措施)。其他类型的手术，如修复和肩部表面修复，占7%。解剖结构显示，无茎肱骨成分的使用率从2017年的2%上升到2022年的10% (β = 1.4；P & lt;. 01)。在经济上，医疗保险医生支付的肩部手术费用从2017年的1882美元显著下降到2023年的1428美元(β = - 73；P & lt;措施)。通货膨胀调整后的aTSA成本也从2013年的8055美元下降到2022年的6223美元(β = - 173.56；P & lt;.01)， 2022年RSA从12,207美元降至8882美元(β = - 318.31；P & lt;措施)。结论：与aTSA相比，初级TSA手术的趋势是RSA越来越普遍，此外在aTSA内无茎肱骨植入物也在增加。随着医疗保险医师报销和植入物价格的持续下降，外科医生在进行此类手术时考虑不同植入物材料和患者特定技术的权衡是很重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in Arthroplasty Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

104

期刊介绍： Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.