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J Shoulder Elbow Surg. 2014 Mar 4. pii: S1058-2746(13)00619-8. doi: 10.1016/j.jse.2013.12.008. [Epub ahead of print]

Nationwide shoulder arthroplasty rates and revision burden in Germany: analysis of the national hospitalization data 2005 to 2006.

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  • 1Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Germany.
  • 2Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Germany; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA. Electronic address: andreas.stang@uk-halle.de.



The aim of this study was to provide nationwide shoulder arthroplasty rates in Germany based on the national hospitalization file and to estimate the revision burden for shoulder arthroplasty and its determinants.


We analyzed the nationwide, population-based, German diagnosis-related groups data from the years 2005 and 2006. Procedure codes and diagnosis were analyzed for each hospitalization. Overall, 16,488 primary shoulder arthroplasties and 1302 revisions were performed during the study period. Age-standardized rates, age-specific rates, rates by indication, and revision burden were calculated.


The age-standardized hemiarthroplasty (HA) rates were 3.6 per 100,000 person-years (standard error [SE], 0.1) for men and 9.3 per 100,000 person-years (SE, 0.1) for women and clearly exceeded the age-standardized total shoulder arthroplasty (TSA) rates of 1.7 per 100,000 person years (SE, 0.1) for men and 3.7 per 100,000 person-years (SE, 0.1) for women. The revision burden was 4.7% for HA and 15.0% for TSA. Multivariable-adjusted analysis showed increasing age was associated with a lower relative burden of revision, and an increased Charlson comorbidity index and male gender were associated with a higher relative burden of revision. The adjusted relative burden of revision was considerably higher for TSA than for HA (adjusted relative burden of revision, 2.89; 95% confidence interval, 2.60-3.22).


We found more than 2-fold higher primary rates for HA than for TSA and up to 3-fold higher shoulder arthroplasty rates for women than for men. TSA had a 3-fold higher relative burden of revision than HA.

Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.


Germany; Shoulder arthroplasty rates; revision burden; risk factor; shoulder hemiarthroplasty; total shoulder arthroplasty

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