This retrospective epidemiological study used the National Inpatient Sample to track trends in primary RTSA, anatomic TSA, and shoulder hemiarthroplasty across the United States from 2012 to 2017. It asks how the volume and patient demographics of each procedure changed over time. Over 508,000 cases were analyzed using population-adjusted, sex-adjusted, and age-adjusted incidence rates.
RTSA went from fewer than 23,000 procedures annually in 2012 to over 62,000 by 2017, a nearly 3-fold increase driven by expanding indications, a growing fellowship-trained workforce, and shifting practice patterns toward younger patients.
For a trainee, two trends matter most for clinical practice and boards. First, hemiarthroplasty for the shoulder has largely been displaced: by 2017, only about 4,900 were performed nationally, compared to over 103,000 combined RTSA and anatomic TSA cases. Second, the rise of RTSA in the 50-64 age group signals that age alone is no longer a contraindication — but TSA under age 50 remains uncommon (0.3 per 100,000 for RTSA), and this distinction is testable.
On the indication side, cuff tear arthropathy is still the leading diagnosis for RTSA, but osteoarthritis as a listed diagnosis grew from 23.6% to 32.9% of RTSA cases. This reflects real-world expansion of RTSA use beyond its original FDA approval, though coding limitations (no specific ICD code for rotator cuff arthropathy) mean some OA-coded cases may have underlying cuff pathology.
Knowing these trends helps you contextualize where shoulder arthroplasty practice is heading and why RTSA-specific surgical training has become increasingly central to shoulder fellowship curricula.
This retrospective epidemiological study used the National Inpatient Sample to track trends in primary RTSA, anatomic TSA, and shoulder hemiarthroplasty across the United States from 2012 to 2017. It asks how the volume and patient demographics of each procedure changed over time. Over 508,000 cases were analyzed using population-adjusted, sex-adjusted, and age-adjusted incidence rates.
RTSA went from fewer than 23,000 procedures annually in 2012 to over 62,000 by 2017, a nearly 3-fold increase driven by expanding indications, a growing fellowship-trained workforce, and shifting practice patterns toward younger patients.
For a trainee, two trends matter most for clinical practice and boards. First, hemiarthroplasty for the shoulder has largely been displaced: by 2017, only about 4,900 were performed nationally, compared to over 103,000 combined RTSA and anatomic TSA cases. Second, the rise of RTSA in the 50-64 age group signals that age alone is no longer a contraindication — but TSA under age 50 remains uncommon (0.3 per 100,000 for RTSA), and this distinction is testable.
On the indication side, cuff tear arthropathy is still the leading diagnosis for RTSA, but osteoarthritis as a listed diagnosis grew from 23.6% to 32.9% of RTSA cases. This reflects real-world expansion of RTSA use beyond its original FDA approval, though coding limitations (no specific ICD code for rotator cuff arthropathy) mean some OA-coded cases may have underlying cuff pathology.
Knowing these trends helps you contextualize where shoulder arthroplasty practice is heading and why RTSA-specific surgical training has become increasingly central to shoulder fellowship curricula.