An Update on Shoulder and Elbow Procedures

Maria Shepherd • Data Decision Group

There was a time several years ago when shoulders trailed hips and knees in repair/revision procedure volume. For years, hip and knee repair topped the list of the most repaired joints as the aging baby boomer population and a new generation of younger adults (the often overlooked Generation X) drove demand for lower extremity arthroplasties. Such demand has slowed in recent years, however, enabling shoulders to move closer to the top of the “most repaired joint” list in the United States. In fact, there is growing evidence that demand for upper extremity arthroplasty will continue to grow in the immediate future. An article in the Journal of Shoulder and Elbow Surgery titled, “Prevalence and Projections of Total Shoulder and Elbow Arthroplasty in the United States to 2015,” concludes that growth in demand for upper extremity arthroplasty is greater than the growth in demand for hip and knee arthroplasty.1The article’s authors reported estimated procedure annual growth rates by procedure type (Chart 1).

The Importance of Revision Surgery

In their article, the authors addressed their concern about the fast growth of the number of revisions for upper extremities, noting revision surgery is considered more complex than primary arthroplasty. They compared primary and revision total knee and hip arthroplasty procedures to those of upper extremities and reported that hip and knee primary and revision procedures are projected to grow at lower rates.2

Procedure Volumes

The JSES study analyzed discharge records from 1993-2007 to project procedure rate estimates to 2015 (see Chart 1). However, the JSES procedure rate numbers did not correlate with the figures presented in Chart 2, obtained from another, more current data provider. The differentiation also may be due to the source of the JSES study data—the National Inpatient Sample—which does not include outpatient information.3 And while the JSES procedure rate figures differ from the National Inpatient Sample, the magazine’s study nevertheless provided some important information.3

The study reached the following conclusions: Procedure rates were consistently higher for women than for men, and lower for non-whites vs. whites.

Drivers to increasing procedure rates:

• The number of surgeons reporting a practice focus in shoulders increased to 25.1 percent in 2008;

• Greater acceptance of the surgical legitimacy and positive clinical outcomes of shoulder and elbow procedures;4

• An aging population and more active lifestyles;

• An increase in reported level of osteoarthritis to 22 percent for doctor diagnosed arthritis (adults, all ages);5 and

• An increase in reported level of osteoarthritis to 50 percent for doctor diagnosed arthritis (older than 65).5

Annual procedure rates for shoulder and elbow surgery may have slowed since 2009, due to the recession. However, the shoulder and elbow surgery market is one where technology makes a difference, and the opportunity for medicaldevice innovation continues.

References:

1. Day, J., et. al, J Shoulder Elbow Surg (2010) 19, 1115-1120

2. Kurtz SM, Ong KL, Schmier J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007;89(suppl 3):144-51. doi: 10.2106/JBJS.G.00587

3.http://www.hcup-us.ahrq.gov/ nisoverview.jsp

4.http://www.aaos.org/research/stats/specialtyareas.pdf

5. MMWR 2010;59(39);1261-1265. [Data Source: 2007–2009 NHIS]

6. MRG U.S. Markets for Arthroscopy Devices, 2009

Author’s note: Readers are invited tosubmit market data and trend questions to Maria Shepherd. Periodically, selected questions will be presented in this column with answers from Maria. Send your questionsto [email protected]. We lookforward to your feedback.

Maria Shepherd, founder of Data Decision Group, has 20 years of leadership experience in medical device/lifesciences marketing in small startups and top-tier companies. The firm quantitatively and qualitatively sizesopportunities, evaluates new technologies,and assesses prospective acquisitions.

Shepherd can be reached at (617) 548-9892or at [email protected] or www.ddecisiongroup.com.