Patient Demographics for Total Shoulder Arthroplasty

Total shoulder arthroplasty has become an increasingly common orthopedic procedure, reflecting both the aging population and expanding indications for shoulder replacement. A review of recent literature reveals consistent demographic trends for total shoulder surgery related to patient age, sex, race and ethnicity, comorbidities, and temporal patterns, all of which have implications for patient selection, perioperative care, and long-term outcomes.

Patients undergoing total shoulder arthroplasty are typically older adults. Large national registry and database studies consistently report that individuals aged 65 to 79 years make up the largest proportion of patients compared to other age groups. For example, a U.S. National Inpatient Sample analysis found the highest incidence among patients aged 64–79 years, while a registry-based study in England reported a rise in mean patient age from 67.9 years in 1999 to 72.4 years in 2019. Age correlates strongly with underlying degenerative joint disease, which remains the leading indication for the procedure. These findings emphasize that shoulder arthroplasty is primarily a procedure of later life, though recent reports indicate an increasing number of younger patients (<65 years) receiving total shoulder surgery for expanded indications such as post-traumatic arthritis and cuff tear arthropathy.

Gender distribution shows a modest but consistent female predominance. In several large cohort and systematic studies that included patient demographics, women accounted for 55–65% of total shoulder arthroplasty recipients. This may reflect both the higher prevalence of osteoarthritis in women and longer female life expectancy. Moreover, female gender has been linked to greater postoperative complication rates and longer hospital stays, potentially due to differences in bone quality, comorbidity burden, or perioperative care needs.

Race and ethnicity data are less frequently reported, though available U.S. studies suggest that the majority of patients are White. Some analyses also indicate that African American and Hispanic patients are underrepresented relative to disease burden, hinting at disparities in access to elective orthopedic care.

Comorbidities play a significant role in the demographic profile of total shoulder arthroplasty patients. In a nationwide U.S. cohort of nearly 13,000 patients from 2011 to 2016, the mean age was 69.1 years and 56.1% were female, with common comorbid conditions including diabetes (17.4%), hypertension, and obesity. Higher comorbidity indices have been linked to prolonged hospital stays and greater perioperative risk. These findings underscore the importance of preoperative medical optimization and individualized surgical planning in an older, often medically complex population.

Trends over time show a clear increase in number of total shoulder arthroplasties being performed. Between 1995 and 2017, the prevalence of any shoulder arthroplasty in the U.S. increased eightfold, and similar growth has been documented internationally. This pattern raises concerns about long-term revision demand and healthcare resource utilization as more patients live longer with their implants.

In summary, the typical patient undergoing total shoulder arthroplasty is a woman in her late 60s or early 70s, often White, with multiple medical comorbidities. Over time, the procedure has expanded to include younger and more diverse populations. Understanding these demographic patterns is essential for risk assessment, surgical planning, and policy development to ensure equitable and effective delivery of total shoulder arthroplasty care worldwide.

References

1. Issa K, Pierce CM, Pierce TP, et al. Total shoulder arthroplasty demographics, incidence, and complications: a nationwide inpatient sample database study. Surg Technol Int. 2016;29:240-246. https://pubmed.ncbi.nlm.nih.gov/27608744/
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3. Saltzman BM, Basques BA, Leroux T, et al. The influence of gender on early adverse events, hospital charges, and length of stay after shoulder arthroplasty. Int Orthop. 2018;42(1):149-155. DOI: 10.1007/s00264-017-3547-6
4. Shah AA, et al. Trends in total shoulder arthroplasty from 2005 to 2018: lower complication rates and shorter lengths of stay despite patients with more comorbidities. J Shoulder Elbow Surg. 2020;29(12):2369-2379. DOI: 10.1016/j.jseint.2020.04.024
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