JSES - 2026-04-07 - Journal Article
Evolving Trends in Shoulder Arthroplasty: A Decade of Growth and Future Projections in Comparison with Hip and Knee Arthroplasty.
Heo KY, Tornberg HN, Bailey EP, Conn V, Lee JD, Gottschalk MB, Zelenski NA, Wagner ER
Topics
Key Takeaway
Total shoulder arthroplasty volume increased 212% from 55,245 to 172,559 procedures between 2012 and 2022, with projected volumes reaching 334,000–905,000 by 2035—a growth rate exceeding both THA (45%) and TKA (25%) over the same period.
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Summary
This study queried the NIS and NASS using ICD and CPT codes to characterize national shoulder, hip, and knee arthroplasty trends from 2012–2022 and project volumes to 2035. TSA increased 212% (17.6 to 51.7 per 100,000), driven predominantly by RSA, while shoulder hemiarthroplasty declined 55%. Log-linear regression projects TSA reaching 334,000–905,000 annual procedures by 2035, with the largest growth in the 65–74 age cohort.
Key Limitation
The wide projection range (334,000–905,000) reflects model uncertainty and does not account for potential saturation effects, payer policy changes, or disruptive technologies that could alter adoption curves.
Original Abstract
INTRODUCTION
Total shoulder arthroplasty, especially reverse shoulder arthroplasty, has expanded rapidly, yet contemporary national trends and projections relative to hip and knee arthroplasty are not fully defined. This study evaluates trends of shoulder arthroplasty in the United States from 2012 to 2022 and projects volumes through 2035.
METHODS
The National Inpatient Sample (NIS) and National Ambulatory Surgery Sample (NASS) were analyzed using ICD and CPT codes to identify shoulder, hip, and knee arthroplasty procedures. Annual procedural volume and incidence per 100,000 population were calculated by age and sex. Linear, log-linear, and logistic regression models projected future trends to 2035.
RESULTS
Between 2012 and 2022, total shoulder arthroplasty increased 212% from 55,245 to 172,559 procedures, with incidence rising from 17.6 to 51.7 per 100,000. In the same time period, total hip and knee arthroplasty increased by 45% and 25%, respectively. Shoulder hemiarthroplasty declined by 55%. Growth was observed across all age and sex groups, with the largest increase in patients aged 65 to 74 years. Log-linear projections show that the growth rate of total shoulder arthroplasty exceeds the growth rate of hip and knee arthroplasty, with estimates in 2035 reaching 334,000 to 905,000 procedures.
DISCUSSION
Our study demonstrates that shoulder arthroplasty continues to grow exponentially while shoulder hemiarthroplasty declines. These trends highlight the importance of healthcare planning, surgical workforce preparation, and patient counseling for an aging population with expanding shoulder arthroplasty indications.