JSES - 2026-03-26 - Journal Article
Reassessing the Arthroplasty Landscape: Updated Incidence and Future Projections of Shoulder Arthroplasty Compared With Hip and Knee Arthroplasty in the United States.
Joshi T, Kalva S, Fucich D, Molokwu BO, Xu JJ, Vallurupalli N, Zuckerman JD, Virk MS
Topics
Key Takeaway
TSA incidence grew 248% from 2015–2025 (13.1 to 45.6 per 100,000) and is projected to increase by 73–397% by 2040, representing the highest proportional annual growth rate (12.4%/year by Poisson modeling) of any major arthroplasty.
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Summary
Using a large U.S. database, the authors calculated annual TSA, THA, and TKA incidence and prevalence from 2015–2025 and projected volumes through 2040 using linear and Poisson regression. TSA incidence rose 248% over the study period, with prevalence increasing 437% to 222.8 per 100,000; Poisson modeling projects a 397% further increase by 2040 under baseline assumptions and a 2,318% increase using post-COVID growth rates. Despite remaining less common than THA or TKA in absolute volume, TSA demonstrated the highest proportional annual growth at 12.4% per year.
Key Limitation
Projection accuracy is highly model-dependent, with the Poisson post-COVID estimate (2,318% increase) almost certainly reflecting pandemic rebound artifact rather than a sustainable growth trajectory, making the true 2040 volume highly uncertain.
Original Abstract
BACKGROUND
Total shoulder arthroplasty (TSA) utilization has increased rapidly following the adoption of the reverse TSA (rTSA). Contemporary forecasts of TSA incidence and prevalence are limited and outdated, particularly in comparison with total hip arthroplasty (THA) and total knee arthroplasty (TKA). We sought to update TSA projections in the United States through 2040 and compare them against THA and TKA.
METHODS
We identified adults (≥18 years) who underwent primary TSA, THA, or TKA between 2015 and 2025 in the United States using a large database. Annual incidence (new procedures per 100,000 patients) and prevalence (patients with prior arthroplasty per 100,000) were calculated. For each arthroplasty, linear and Poisson regression models were used to project new cases through 2040, with 95% confidence intervals. COVID year exclusion analysis and segmented analyses were performed using pre and post-COVID years in both linear and Poisson regression models to assess the effect of accelerated post-pandemic rebound.
RESULTS
From 2015-2025, we identified 83,203 new TSA, 267,683 new THA, and 354,044 new TKA cases. TSA incidence increased from 13.1 to 45.6 per 100,000 (248.1% change), and prevalence from 41.5 to 222.8 per 100,000 (436.9% change). Across both modeling approaches, new cases for all procedures increased significantly. In Poisson modeling, the greatest proportional annual growth was observed for TSA (12.4% per year), compared with TKA (9.1% per year) and THA (8.5% per year). With linear regression, incidence increased by 2.77 cases per 100,000 per year for TSA, 8.75 for TKA, and 6.26 for THA, with TKA showing the largest additive yearly increase. By 2040, the linear model predicts that shoulder arthroplasty volume will increase by 73.0% to 78.9 cases per 100,000, whereas the Poisson model predicts a 397.4% increase, to 226.8 cases per 100,000. Utilizing post-COVID years, the linear model predicts that TSA volume will increase by 212.9% to 142.7 cases per 100,000, whereas the Poisson model predicts a 2317.8% increase, to 1102.5 cases per 100,000.
CONCLUSION
TSA utilization in the United States has increased significantly over the past decade and is projected to continue rising through 2040. Although TSA remains less common than THA or TKA, it demonstrated the greatest proportional annual growth by Poisson modeling from 2015 to 2025, with much of this acceleration concentrated in the post-COVID period. These updated projections provide essential data for clinicians, health-system leaders, and policymakers as they plan for the growing burden of shoulder arthroplasty.