Utilisation of shoulder arthroplasty in the UK

To estimate the per capita utilisation of shoulder prostheses in the UK and to compare UK figures to those from the US.

A postal and telephone survey was undertaken of all hospitals in the UK carrying out orthopaedic operations. The relative usage of total shoulder replacement and hemi-arthroplasty for both elective and trauma indications were analysed and UK figures compared to those from the US.

There were 281 replies from 314 questionnaires, a response rate of 90%. The per capita rate of shoulder replacement is approximately one-tenth for total replacement and one-fifth for hemiarthroplasty compared to the US, suggesting that there is an unmet demand in the UK. In the US, the proportion of total replacements to hemi-arthroplasties for elective indications is approximately equal whereas in the UK there are twice as many hemi-arthroplasties, which raises the question as to whether hemi-arthroplasties are being used when a total replacement might be preferable. The numbers of shoulder arthroplasties implanted by individual surgeons and units is, except for a few large centres, small. Consequently, it is much more difficult for the surgeon to evaluate the various prosthetic designs and surgical techniques.

There is a need for a national register to increase the knowledge about such designs and techniques and to analyse risk factors.