The rising incidence and future trends of revision total shoulder arthroplasty

With the introduction of reverse total shoulder arthroplasty (TSA) in the United States in 2004, the indications for TSA have expanded significantly, leading to a dramatic rise in primary and revision TSA procedures. Despite these increases in utilization, the epidemiology of revision TSA has not been studied on a large scale. The purpose of this study is to determine the epidemiology of revision TSA over the past 10 years and forecast the incidence over the next 5 years.

In this retrospective cohort study, the TriNetX US Collaborative Network database was queried from 2015-2024 using Current Procedural Terminology codes 23473, 23474, and 1021145 to identify patients undergoing revision TSA. This database includes deidentified electronic health record data from 67 US healthcare organizations; therefore, findings reflect patients treated within the United States only. This query resulted in 70,349 patients who underwent revision during the study period. The data were analyzed using linear regression modeling to determine if there was a significant trend in the incidence of revision TSA. Poisson analysis was performed to calculate incidence rate ratios between years during the study period. An AutoRegressive Integrated Moving Average model was used to project future trends in the incidence of revision TSA through the year 2030.

The incidence of revision TSA increased from 223 to 1,247 cases per 100,000 person-years 2015 to 2024, a 5.6-fold increase. Poisson analysis shows a significant and steady upward trend, with notable acceleration in the recent years (P < .001). The Poisson-based AutoRegressive Integrated Moving Average model of revision TSA volume projects growth to 1,929 cases per 100,000 person-years by 2030 (R² = 0.88, mean absolute percentage error = 16%).

The incidence of revision TSA has steadily increased from 2015 to 2024, with a greater than 5-fold increase over the study period and a marked acceleration in recent years. Time series forecasting projects a continued upward trend with a more than 50% increase in cases from 2025-2030, indicating a growing burden on healthcare systems. Sustained increases in revision procedures will require expanded healthcare resources and specialized training to meet the growing surgical demand.