Changing Utilization of Primary Anatomic and Reverse Shoulder Arthroplasty in a Single High-Volume Institution: A Retrospective Cohort Study.

Abstract

Objective: The incidence of total shoulder arthroplasty (TSA) in the United States continues to climb as an aging yet active population increases demand for the procedure. Due to promising clinical results out of Europe, improvement in prosthesis design, and wider acceptance of reverse total shoulder arthroplasty (rTSA), this study was designed to evaluate how rTSA and anatomical TSA (aTSA) utilization, patient selection, and length of stay have changed at a single institution.

Methods: This was a retrospective cohort study of patients from one hospital system between 2017 and 2023. Inclusion criteria included primary TSA cases using CPT codes. Exclusion criteria included hemiarthroplasty, revision arthroplasty, non-arthroplasty procedures. Primary arthroplasty procedures were separated into reverse or anatomic cohorts for analysis. Independent sample t-tests were used to compare continuous data between the first and last year of cohort data and to compare parameters between procedure types. Chi-square analysis was used for frequency-based data comparisons. Type-I error was set at α=0.05 for all analyses.

Results: From all 2774 shoulder arthroplasty cases identified, 2604 TSA cases were included in the final statistical analyses, 2114 of which were rTSA and 490 anatomic TSA. Comparison of arthroplasties in 2017 and 2023 revealed, rTSA increased from 115 surgery cases to 549, or 77.18% to 82.81% over the study period (p < 0.001). Anatomic TSA increased in total surgery cases from 29 to 111, (p = 0.655) and thus signifies an overall decrease in anatomic surgery utilization from 19.46% to 16.74%. Data showed an increase in average patient age for rTSA and decreased procedure time and length of stay for both groups.

Conclusion: rTSA utilization has surpassed and continues to increase relative to anatomic TSA. Peri-operative management of shoulder replacement has become more efficient with significantly decreased procedure time and decreased total hospital length of stay after primary TSA.