Reverse total shoulder arthroplasty projected to increase 20-fold by 2040, outpacing growth in anatomic total shoulder arthroplasty
- 1Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
- 2Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
Abstract
Background: Reverse total shoulder arthroplasty (TSA) was introduced in the United States in 2004, and its indications have since broadened considerably relative to anatomic TSA. Despite this shift, long-term national projections comparing these 2 techniques remain limited. The purpose of this study is to determine trends in TSA utilization over the past decade and project volume through 2040.
Methods: In this retrospective cohort study, the PearlDiver Mariner database was queried from 2011 to 2019 using the International Classification of Diseases, ninth and 10th Revision, procedural codes to identify patients undergoing TSA. This database aggregates claims data from over 174 million patients across multiple payers, reflecting United States care only. Multiple forecasting models were evaluated to project anatomic, reverse, and overall TSA volume through 2040.
Results: Between 2011 and 2019, overall TSA volume increased 242%, from 9,253 to 31,656 procedures, with 9,067 anatomic and 22,589 reverse TSA procedures recorded in 2019. By 2040, anatomic TSA volume is projected to reach 14,638 procedures (95% confidence interval [CI]: 11,874–16,958), a 61% increase from 2019, while reverse TSA volume is projected to reach 517,472 procedures (95% CI: 372,130–707,073), a 2,191% increase. Overall TSA volume is projected to reach 418,531 procedures (95% CI: 265,531–644,833) by 2040, a 1,222% increase from 2019. The AutoRegressive Integrated Moving Average model demonstrated the strongest fit among candidate models, with mean absolute percentage errors around 5% for anatomic, reverse, and overall TSA volume.
Conclusion: Procedural forecasts indicate that primary TSA growth through 2040 will be largely driven by reverse TSA, which is projected to increase more than 20-fold from 2019 levels compared to a 61% increase in anatomic TSA. These trends reinforce the need for surgical training, workforce planning, and patient counseling as reverse TSA indications expand.
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BibTeX
@article{wang2026reverse,
title = {{Reverse total shoulder arthroplasty projected to increase 20-fold by 2040, outpacing growth in anatomic total shoulder arthroplasty}},
author = {Eric Wang and Jasmine K.M. Lopez and Alejandro M. Holle and Amy M. Zeller and M. Lane Moore and Jeffrey D. Hassebrock and John M. Tokish},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100104},
url = {https://doi.org/10.1016/j.jsea.2026.100104},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Reverse total shoulder arthroplasty projected to increase 20-fold by 2040, outpacing growth in anatomic total shoulder arthroplasty
AU - Eric Wang
AU - Jasmine K.M. Lopez
AU - Alejandro M. Holle
AU - Amy M. Zeller
AU - M. Lane Moore
AU - Jeffrey D. Hassebrock
AU - John M. Tokish
PY - 2026
DA - 2026/09/30
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100104
UR - https://doi.org/10.1016/j.jsea.2026.100104
AB - Background: Reverse total shoulder arthroplasty (TSA) was introduced in the United States in 2004, and its indications have since broadened considerably relative to anatomic TSA. Despite this shift, long-term national projections comparing these 2 techniques remain limited. The purpose of this study is to determine trends in TSA utilization over the past decade and project volume through 2040. Methods: In this retrospective cohort study, the PearlDiver Mariner database was queried from 2011 to 2019 using the International Classification of Diseases, ninth and 10th Revision, procedural codes to identify patients undergoing TSA. This database aggregates claims data from over 174 million patients across multiple payers, reflecting United States care only. Multiple forecasting models were evaluated to project anatomic, reverse, and overall TSA volume through 2040. Results: Between 2011 and 2019, overall TSA volume increased 242%, from 9,253 to 31,656 procedures, with 9,067 anatomic and 22,589 reverse TSA procedures recorded in 2019. By 2040, anatomic TSA volume is projected to reach 14,638 procedures (95% confidence interval [CI]: 11,874–16,958), a 61% increase from 2019, while reverse TSA volume is projected to reach 517,472 procedures (95% CI: 372,130–707,073), a 2,191% increase. Overall TSA volume is projected to reach 418,531 procedures (95% CI: 265,531–644,833) by 2040, a 1,222% increase from 2019. The AutoRegressive Integrated Moving Average model demonstrated the strongest fit among candidate models, with mean absolute percentage errors around 5% for anatomic, reverse, and overall TSA volume. Conclusion: Procedural forecasts indicate that primary TSA growth through 2040 will be largely driven by reverse TSA, which is projected to increase more than 20-fold from 2019 levels compared to a 61% increase in anatomic TSA. These trends reinforce the need for surgical training, workforce planning, and patient counseling as reverse TSA indications expand.
SN - 2471-5492
ER -