Total shoulder arthroplasty in France: An analysis of trends between 2009 and 2019 and projections to the year 2070
Prothèse totale d'épaule en France : analyse des tendances entre 2009 et 2019 et projection à l'horizon 2070
Abstract
Background: Over the past decades, total shoulder arthroplasty (TSA) procedures have steadily increased
in the United States and Europe. In France, the number of shoulder surgeries rose by 24.5% between 2012
and 2018, but no study has yet analyzed TSA trends based on patient characteristics. Therefore, the aim of
our study was to use the French healthcare database to (1) analyze growth trends based on the patient’s
sex, age, and comorbidity profile and (2) estimate the most appropriate incidence rate (IR) projections to
the year 2070.
Hypothesis: We hypothesize that in France, the upward trends are different for each sex and age group.
Materials and methods: This study was conducted in France from 2009 to 2019 based on the French
healthcare database (SNDS), which contains all nationwide procedures. Patients were analyzed by sex,
age group (< 65 years, 65–74 years, ≥ 75 years), and comorbidity profile (4 levels). IR trends per 100,000
population were inferred by patient age, sex, and comorbidity using data from the French hospital discharge database (PMSI) and population forecasts and censuses from the French National Institute of
Statistics and Economic Studies (INSEE). Linear, Poisson, logistic, and Gompertz projection models were
created to forecast IRs to the year 2070.
Results: Between 2009 and 2019, there was a sharper increase in IR in males (+155%; from 6.0 to 15.3)
than in females (+118%; from 16.2 to 35.3) across all age groups. This increase was most significant in
those younger than 65 years (+112%; from 2.3 to 4.9), in both males (+129%; from 2.1 to 4.8) and females
(+99%; from 2.5 to 5.0). From 2012 to 2019, the proportion of patients with mild comorbidities increased
by +92% (from 5,435 to 10,410 TSAs, i.e., from 56% to 61% of total procedures), unlike the other comorbidity
profiles. All the projections modeled the data from 2009 to 2019 with minor deviations. However, the
logistic projection was the most likely, with a 45% increase in the IR for the overall population by 2070
(from 17,175 to 25,338 TSAs), which will start to plateau in 2050.
Conclusion: The IR has risen sharply in the overall population, as in all age, sex, and comorbidity categories,
with the most significant growth seen in the < 65 and 65–74 age groups and a shift toward patients with
milder comorbidities. According to our projections, the IR will continue to be more significant in older
patients, except for males, for whom the IR for those 65 to 74 years old will exceed that of those 75 and
older around 2030. In the longer term, the IRs follow a logistic trend, reaching a plateau around 2050.
Therefore, an increase in healthcare burden is to be expected to meet the growing demand for TSAs.
Level of evidence: IV; Descriptive epidemiological study.