Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: A multi-level study of Australian registry data

Round: Associations between socioeconomic position ( SEP ) and the uptake of primary total shoulder arthroplasty ( TSA ) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry ( AOA NJRR ) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007–11 for all Australians aged ≥40 years. Methods: Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures > 99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level ( categorised into deciles ), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. Results: During 2007–11, we observed 6,123 TSA ( 62.2 % female ). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Conclusions: Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.

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