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Updated: Jul 12, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Shoulder Procedure Volumes in Orthopaedic Residency: Long-Term Disparities and a Case for Arthroplasty Minimums
Joshua U Hancock1, Jordan H Larson, Kaitlyn N Christmas
1From the Foundation for Orthopaedic Research and Education (Hancock, Dr. Larson, Christmas), Department of Translational Research, Tampa, FL; the University of South Florida (Dr. Patel, Dr. Schmidt), Department of Orthopaedic Surgery, Tampa, FL; the James A. Haley Veteran's Administration Hospital (Dr. Chebli), Department of Orthopaedic Surgery, Tampa, FL; and the Florida Orthopaedic Institute (Dr. Frankle), Shoulder Service, Tampa, FL.
Background:
Total shoulder arthroplasty (TSA) has experienced rapid growth. Yet graduating orthopaedic surgery resident (GOSR) TSA volumes are not individually reported due to its exclusion from the Accreditation Council for Graduate Medical Education (ACGME) case minimum list. Rather, TSAs are grouped within the shoulder repair/revision/reconstruction (RRR) category. This study evaluated long-term trends and identified disparities in GOSR shoulder case volumes since the inception of case minimums in 2013.
Methods:
Publicly available ACGME case logs of 8247 GOSRs were analyzed from 2014 to 2024. Average case volumes were compared between 2014 and 2024. Trends in case volume differences between the 10th and 90th percentile GOSRs were assessed. Changes in the proportions of each procedure category relative to overall shoulder procedures were analyzed.
Results:
GOSRs performed more shoulder RRR and overall shoulder cases in 2024 than in 2014 (RRR: 46.4 vs. 24.2 cases [+91.7%]; overall: 174.9 vs. 125.9 cases [+38.9%]; P < 0.001). Differences in shoulder RRR and overall shoulder procedures between the 10th and 90th percentiles increased year-over-year (+2.86 and +5.11 cases/year, respectively; P < 0.001), with the gap between percentile groups demonstrating consistent expansion (RRR: ρ = 0.975; overall: ρ = 0.961; P < 0.001). Relative to overall shoulder procedures, the proportion of shoulder RRRs increased from 2014 to 2024 (19.2% to 26.5%, P = 0.045).
Conclusion:
Although average GOSR shoulder case volumes increased over the long term, interresident disparities widened. Shoulder RRRs expanded to more than one fourth of resident shoulder procedures, paralleling TSA growth nationally. Residency governance bodies should consider implementing a resident TSA case minimum to ensure experience in this important procedure.