Is popularity of total elbow arthroplasty in the United States decreasing? An analysis of trends, demographics, and indications

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.