Use of reverse total shoulder arthroplasty in the Medicare population

Reverse shoulder arthroplasty (RSA) has been Food and Drug Administration approved in the United States since 2004 but did not obtain a unique code until 2010. Therefore, the use of this popular procedure has yet to be reported. The purpose of this study was to examine the use and reimbursement of RSA compared with total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (SHA).

We analyzed the 100% sample of the 2011 Medicare Part A claims data for patients aged 65 years or older. Patient demographic characteristics, diagnoses, provider information, reimbursements, and lengths of stay were extracted from the claims data.

In 2011, a total of 31,002 shoulder arthroplasty procedures were performed; 37% were RSAs, 42% were TSAs, and 21% were SHAs. Osteoarthritis was the primary diagnosis code in 91% of TSAs, 37% of SHAs, and 45% of RSAs. A primary diagnosis of osteoarthritis with no secondary code for rotator cuff tear was found in 22% of patients undergoing RSA. The mean length of stay for RSA (2.6 days; SD, 2.1 days) was longer than that for TSA (2.1 days; SD, 1.5 days) and shorter than that for SHA (3.5 days; SD, 3.6 days) (P < .001). Lower-volume surgeons (<10 arthroplasties per year) performed most shoulder arthroplasties: 57% of RSAs, 65% of TSAs, and 97% of SHAs. Seventy percent of RSAs were implanted by surgeons who performed more RSAs than TSAs and SHAs combined.

RSA is performed with similar frequency to TSA and almost twice as much as SHA in the Medicare population. Lower-volume surgeons perform most RSAs, and a majority of surgeons perform more RSAs than all anatomic shoulder arthroplasties combined.