Progression and projection for shoulder surgery in France, 2012-2070: Epidemiologic study with trend and projection analysis.
INTRODUCTION
Shoulder surgery has been rapidly expanding over the past 20 years and now makes up a large share of orthopedic surgery practice. Data on how this activity has changed is not available in France due to a lack of registries. The study objectives were to: (1) quantify the number of shoulder surgeries in France, (2) predict how this activity will change over the next 50 years based on extreme scenarios.


METHODS
This study involved an analysis of shoulder surgery data taken from the French hospital discharge database (PMSI). Two mathematical scenarios were applied to define the change over time: the first only considered the evolution in the population and changes in the age brackets over time; the second extrapolated the trends observed over the past few years (2012 to 2018).


RESULTS
In 2018, there were 234,612 procedures coded as primary shoulder surgery procedures in France. This activity increased 24.5% between 2012 and 2018 and is projected to increase 18% to 161% from now to 2050, depending on the scenario (p<0.0001). Rotator cuff surgery procedures were done 173,799 times - of which 61,055 were tendon repair - representing 74% of all shoulder procedures. The scenarios point to an increase of 13.6% to more than 300% (p<0.0001). Primary shoulder arthroplasty corresponded to 17,043 procedures in 2018 (7.3% of all procedures), with a 47% increase between 2012 and 2018. Between 2018 and 2050, the number of total shoulder arthroplasty procedures is expected to increase 31% to 322% (p<0.0001). The total number of revision arthroplasty procedures was 1508, increasing by 39% from 2012 to 2018. There were 14,229 procedures done for anterior or posterior instability in 2018 (6% of total). Bone block procedures made up 53% of these cases. This increased 17% between 2012 and 2018, with a projected increase of 5% to 82% up to 2050 (p<0.01).


DISCUSSION
Shoulder surgery is the third largest activity in the orthopedic realm after hip and knee surgery, although it has seen the largest increases in recent years. This growth in shoulder procedures should continue over the next decades.


LEVEL OF EVIDENCE
IV, descriptive epidemiology study.
['Villatte|Guillaume|G|', 'Erivan|Roger|R|', 'Barth|Johannes|J|', 'Bonnevialle|Nicolas|N|', 'Descamps|Stéphane|S|', 'Boisgard|Stéphane|S|']
D016021:Epidemiologic Studies D005602:France D006801:Humans D012086:Reoperation D017006:Rotator Cuff D000070636:Rotator Cuff Injuries D012782:Shoulder D012785:Shoulder Joint D016896:Treatment Outcome
Shoulder Epidemiology Prediction Evolution Instability Cuff tear National data Prosthesis