Study Links Shoulder Surgical Volume and Experience to Improved Outcomes After Shoulder Replacement

Orthopedic surgeons performing fewer than five shoulder replacements per year had significantly higher rates of patient complications and revision surgery compared to those performing more than 28 or more procedures annually, according to a new study published in the Journal of Shoulder and Elbow Arthroplasty.

"These findings reinforce the importance of subspecialization in achieving the best possible outcomes for patients," said Hafiz F. Kassam, MD, senior author of the study and director of shoulder reconstruction at Hoag Orthopedic Institute. "As shoulder replacement procedures continue to increase nationally, ensuring patients have access to high-volume, specialized surgical care plays a meaningful role in reducing complications and the need for revision surgery."

Hoag Orthopedic Institute is a market leader in shoulder surgery on the West Coast. In 2025, HOI's shoulder surgeons collectively performed more than 2,000 shoulder surgeries, including 670 shoulder replacements,. Dr. Kassam performed nearly 350 of those replacements.

The study analyzed outcomes from 332,542 patients across eight studies to establish evidence-based volume thresholds for shoulder arthroplasty. Surgeons performing fewer than five cases per year had a 41% higher chance of complications and revision compared to higher-volume peers. Surgeons performing between 10 and 20 cases annually showed no statistically significant difference in outcomes compared to one another, suggesting a plateau in that range. However, surgeons performing greater than 28 or more cases per year demonstrated a second, meaningful reduction in both complication and revision rates, defining the threshold for true high-volume subspecialized practice.

Shoulder arthroplasty is among the fastest-growing orthopedic procedures in the United States. National primary total shoulder arthroplasty cases have grown substantially over the past decade, driven by an aging population, increasing prevalence of osteoarthritis and rising demand among younger, active patients. Projections suggest this growth is accelerating, with more than 250,000 total shoulder arthroplasties expected to be performed annually in 2026.