Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures

Abstract

Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010-2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000-44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades.

Keywords: hemiarthroplasty; projections; proximal humerus fracture; reverse shoulder arthroplasty; revision; shoulder arthroplasty.

Figure 1

German population, shoulder arthroplasty incidence (A) and type of procedure (B) from 2010 to 2017.

Figure 2

Historical and projected main indications for reverse shoulder arthroplasty from 2010 to 2040.

Figure 3

Projections of the incidence (A) and total number (B) of shoulder arthroplasties by the year 2040 based on a Poisson (red) and a negative binomial regression model using a monotone B-spline approach (blue). The black points represent the historical numbers.

Figure 3

Projections of the incidence (A) and total number (B) of shoulder arthroplasties by the year 2040 based on a Poisson (red) and a negative binomial regression model using a monotone B-spline approach (blue). The black points represent the historical numbers.

Figure 4

Reported and predicted case numbers per age group from 2010 to 2040.

Figure 5

Projected share of reverse total shoulder arthroplasties (rTSA) in total shoulder arthroplasties from 2010 to 2040.

Figure 6

Projections for revision shoulder arthroplasty procedures using a “constant-rate” approach based on a Poisson (red) and a negative binomial regression model using a monotone B-spline approach (blue).