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Background: Total elbow arthroplasty (TEA) is an effective surgical intervention that can be used in the treatment of elbow pathologies including osteoarthritis (OA), complex distal humerus fractures, and rheumatoid arthritis (RA). However, there is a paucity of literature assessing trends in the utilization of TEA. The purpose of this study was to identify trends in TEA utilization in the United States (U.S.) from 2010 to 2018. Methods: A query of the IBM Watson Health MarketScan Database was performed to identify patients that underwent TEA from 2010 to 2018 using Current Procedural Terminology and International Classification of Disease coding. Patients were stratified based on surgical indication into the following groups: distal humerus fracture/post-traumatic sequelae, RA, OA, and other. Population estimates from the U.S. Census Bureau were used to estimate the annual incidence and procedural trends of primary TEA for each surgical indication. Further stratification evaluated TEA trends based on sex, age, and geographic region. Results: A total of 6522 primary TEAs were performed between 2010 and 2018. The total annual volume of TEAs performed from the start to the end of this time period decreased by 33%, from 694 to 466 cases. Overall, the majority (53.9%, n = 3514) of all TEAs from 2010 to 2018 were performed to treat distal humerus fractures/post-traumatic sequelae, while 22.3% (n = 1457) were performed for RA, 10.8% (n = 702) for OA, and 13.0% (n = 849) for other. Volume and incidence of TEA decreased over time from 2010 to 2018 regardless of surgical indication, sex, and age. The greatest decreases in volume and incidence in TEAs during the study period was observed for RA (58% and 60%, respectively). The smallest change in volume and incidence of TEA was observed for OA, with a 9% decrease in volume from 57 to 52 cases and 14% decrease in incidence from 0.19 to 0.16 per 1,000,000 people. Conclusions: The incidence and volume of primary TEAs in the U.S. decreased from 2010 to 2018, regardless of surgical indication, sex, and age. The most common indication for TEA is distal humerus fractures and traumatic sequelae, and RA is now a much less common indication than it was in the past. Understanding the national trends of TEA utilization allows us to visualize changes in practice over time to highlight preferences in the treatment of various elbow pathologies.

Background: Proximal humerus fractures are the third most common fracture type for patients between the ages of 65 and 89 and occur more frequently in women than men. Given the variety of surgical treatments for proximal humerus fractures, the aim of this study was to (1) report United States national volume and incidence estimates for surgical management of proximal humerus fractures to better understand the changing practice over the past decade and (2) to analyze differences in volume and incidence among age groups, sex, and geographic region. Methods: Using IBM Marketscan national database, all patients that underwent open reduction internal fixation (ORIF), hemiarthroplasty, or reverse total shoulder arthroplasty (RTSA) between 2010 and 2019 were identified with Current Procedural Terminology codes. The dataset was further stratified to identify patients treated for proximal humerus fractures. IBM Marketscan provided discharge weights that were used to determine estimated national annual volumes of each procedure in IBM SPSS Statistics software (IBM Corp., Armonk, NY, USA). Volume and incidence were adjusted per 1,000,000 persons and calculated for subgroups according to age group, sex, and geographical region. The United States Census Bureau annual population data was used for all incidence calculations. Results: Over the past decade, the total volume and incidence of surgically treated proximal humerus fractures increased by 13% and 5%, respectively. Although overall incidence decreased, ORIF remained the most common surgical treatment. The greatest decrease in volume and incidence of ORIF occurred in patients ≥75. The incidence of ORIF treatment increased in the South and West while it decreased in the Northeast and Midwest. Total volume and incidence of HA decreased between 2010 and 2019 and this trend remained among all subgroups. Total volume and incidence of RTSA increased by over 300%. The incidence of males and females receiving RTSA increased by 266% and 320%, respectively. Volume and incidence of RTSA increased across all age groups. Volume and incidence of RTSA increased in the Midwest, South, and Western regions while it remained unchanged in the Northeast. Conclusion: Surgical management trends of proximal humerus fractures have changed greatly over the past decade. ORIF remains the most common surgical treatment for proximal humerus fractures. HA has fallen out of favor while RTSA has seen significant increases in usage across sex, age groups, and geographic regions. These trends represent a change in practice for treating proximal humerus fractures by considering all patient and fracture characteristics when opting for surgical management.