International variation in shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Arthroplasty Registries
• Public Health Surveillance

Background:

• The number of shoulder registries is growing globally.
• Understanding international trends in shoulder arthroplasty is crucial.
• Current data on procedure selection and outcomes requires comprehensive analysis.

Purpose of the Study:

• To assess international trends in shoulder arthroplasty utilization.
• To describe current practices in procedure selection and outcome reporting within national and regional joint registries.
• To identify variations in shoulder arthroplasty data collection and presentation.

Main Methods:

• Analysis of published reports from nine population-based shoulder arthroplasty registries.
• Data extraction on patient demographics, disease indications, surgical procedures, surgeon volume, and outcomes.
• Comparative assessment of data across registries from Norway, Sweden, New Zealand, Denmark, California, Australia, Emilia-Romagna, Germany, and the United Kingdom.

Main Results:

• Shoulder arthroplasty incidence in 2012 was 20 procedures/10^5 population, with a 6-fold variation between countries.
• Annual incidence rates increased 2.8-fold over the past decade.
• Significant variations in procedure selection were observed for osteoarthritis, fracture, and cuff-tear arthropathy indications. Outcome reporting focused on revision, but methods varied, with limited brand-specific data.

Conclusions:

• Shoulder arthroplasty incidence has nearly tripled in the last decade.
• Wide variations in procedure selection, low average surgeon volume, and inconsistent outcome reporting necessitate standardization.
• Increased international registry activity provides a foundation for strengthening evidence in shoulder arthroplasty.