Trends in Shoulder Arthroplasty Across a Large Health System Over the Past 10 Years.

Abstract

Background: The indications and techniques for shoulder arthroplasty (SA) have significantly expanded since the introduction of reverse shoulder arthroplasty (rTSA) in 1991. While national databases provide broad trends, they often lack the granularity needed for patient-specific insights. This study aims to analyze trends in anatomic total shoulder arthroplasty (aTSA), rTSA, and hemiarthroplasty (HA) within a large multihospital system over the past decade.

Methods: We conducted a retrospective review of 2,542 SA cases performed from January 2014 to July 2023 across several hospitals within the Northeast United States (US). Cases were identified using specific Current Procedural Terminology (CPT) codes and were stratified by procedure type: aTSA, rTSA, and HA. Data collected included patient demographics, comorbidities, surgical characteristics, and outcomes. Statistical analyses were performed using one-way ANOVA tests with Bonferroni corrections and Pearson correlations, with significance set at p<0.05.

Results: RTSA increased from 29% to 83.4% of all SA cases during the study period (p<0.001), while aTSA and HA declined to 16.4% and 0.4%, respectively (p<0.001). The mean patient age was 68.7 years, with rTSA patients becoming younger over time (from 75.5 years in 2014 to 71.4 years in 2023, p=0.008). rTSA patients had higher Charlson Comorbidity Index (CCI) scores compared to aTSA and HA (3.4 vs. 2.7 and 2.8, respectively, p<0.001). The use of stemless humeral components in aTSA rose to 26.7% by 2023 (p<0.001), and there was a significant decline in the use of cemented humeral stems for HA (p<0.001). Regional nerve blocks were used at consistently high rates, being performed in 84.5% of cases. Length of hospital stay decreased overall, with an increasing trend toward discharge by postoperative day one, particularly in rTSA and aTSA cohorts.

Conclusion: Over the last decade, there has been an increase in the proportion of rTSA, which is being done increasingly in younger patients with higher ASA scores, comorbidities, and intact rotator cuffs. There has been a rise in stemless aTSA and cementless hemiarthroplasty implants. Finally, patients are increasingly going home on postoperative day one after shoulder arthroplasty, which is likely related to the high rates of regional nerve block usage.