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Rise in radial head arthroplasty utilization in young patients: an analysis of the Nationwide Ambulatory Surgery
Sarah L Larson1,2, Olivia A Swaim1,2, George M Thomas2
1University of Minnesota Medical School, Minneapolis, MN, USA.
Background:
Utilization of radial head arthroplasty (RHA) has increased in recent years, but national age-specific trends in ambulatory RHA use in the United States have not been described. The purpose of this study was to evaluate national trends in ambulatory RHA by age.
Methods:
The Nationwide Ambulatory Surgery Sample (2016-2022) was used to identify adults (≥20 years) undergoing ambulatory RHA for isolated acute radial head or neck fractures. Patients were stratified by age (20-39, 40-59, and ≥60 years). Descriptive statistics and sample-weighted regression models were used to assess temporal trends and factors associated with younger age at surgery. Age- and sex-adjusted national incidence rates were calculated using negative binomial regression.
Results:
A weighted total of 13,453 patients were identified, of which 20.3% were young (20-39 years), 35.9% middle-aged (40-59 years), and 43.9% elderly (≥60 years). Annual ambulatory RHA volume increased from 1,657 cases in 2016 to 2,289 cases in 2022 (+38.1%). The greatest relative increase occurred in young patients (+58.2%), compared with elderly (+47.0%) and middle-aged (+19.5%) patients. Age- and sex-adjusted incidence increased significantly in young patients (0.45 to 0.54 per 100,000; incidence rate ratio: 1.21; 95% confidence interval (CI): 1.05-1.39; P = .009) but stayed stable in elderly patients. Young patients undergoing RHA were more likely to be male (female odds ratio (OR): 0.32; 95% CI: 0.28-0.35; P < .001), have lower household income (highest vs. lowest quartile OR: 0.54; 95% CI: 0.45-0.64; P < .001), and be treated at urban teaching hospitals (OR: 1.49; 95% CI: 1.29-1.72; P < .001) and in the Western region (OR: 1.28; 95% CI: 1.09-1.49; P = .003).
Conclusion:
Overall ambulatory RHA utilization in the United States increased from 2016 to 2022, most significantly in young adults. These findings demonstrate increasing ambulatory utilization of RHA among young adults and highlight the need for longitudinal studies evaluating implant durability, revision risk, and functional outcomes in this population. Whether this trend reflects changes in treatment patterns, referral practices, outpatient migration, or other factors also warrants further investigation.
