Elbow arthroplasty utilization in 2060: projections of primary and revision elbow arthroplasty in the United States in the next 40 years.

Background: In the past decade, the prevalence of end-stage inflammatory elbow arthritis has declined with consequential changes in indications and utilization of total elbow arthroplasty (TEA). Current literature lacks future projections for the utilization of TEA. The aim of this study is to review the trends in the utilization of TEA in the last 2 decades and determine the projections of utilization for TEA (primary and revision) through 2060.

Methods: This analysis used the publicly available 2000-2019 data from the CMS Medicare Part-B National Summary. Procedure volumes including TEA, and revision TEA, were determined using Current Procedural Terminology codes and were uplifted to account for the growing number of Medicare eligible patients covered under Medicare Advantage. Using these volumes, log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average models were applied to generate projections from 2020 to 2060. The Poisson model was chosen to display the data based on error analysis and prior literature.

Results: The projected annual growth rates from 2020 to 2060 for primary and revision TEAs are 1.03% (95% confidence interval: 0.82%-1.25%) and 5.17% (95% confidence interval: 3.02%-6.97%), respectively. By 2060, the demand for primary TEA and revision TEA is projected to be 2084 procedures (95% forecast interval: 1995-2174) and 3161 procedures (95% forecast interval: 3052-3272), respectively. The procedure volume for revision TEA is estimated to outnumber primary TEA by year 2050.

Conclusion: The overall procedural volume of primary TEA and revision TEA continues to be low. Although it is estimated that the incidence of primary and revision TEAs will continue to increase in the next 40 years, the utilization trends only show a mild increase, which is 5 times higher for revision TEA than primary TEA.