Total Shoulder Arthroplasty & COVID-19

Harry Liu

November 22nd, 2022

Asians and African Americans Experienced the Most Disparities in Total Shoulder Arthroplasty During the COVID-19 Pandemic

The following is an abstract of the research report titled “The Impact of the COVID-19 Pandemic on Racial Disparities in Patients Undergoing Total Shoulder Arthroplasty in the United States”, published in JSES International on November 12, 2022. The research was conducted by the Avant-garde Health and Codman Shoulder Society Value Based Care Group. Derek Haas and Xiaoran (Luka) Zhang from Avant-garde Health contributed to the research. The full report is available here:


The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the US and to determine whether these disparities were affected by the COVID-19 pandemic.

Racial disparities have been shown in many areas of medicine and have persisted through the past decade. Achieving health equity and improving access to quality medical care for underrepresented minorities has been a focus for medical societies, patient advocacy groups, and various areas of government, prompting the development of federal programs and policies aimed at reducing health inequality. Despite knowledge of racial disparities and the implementation of various policies and methods to reduce them, racial disparities have persisted in the US for a myriad of surgical procedures including shoulder arthroplasty.

For the study, Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April 2019 to December 2020. Utilization was assessed for White/Black/Hispanic/Asian populations to determine if COVID-19 affected these groups differently.

Findings and Conclusions

COVID-19 exacerbated the preexisting racial disparities for TSA utilization among Medicare beneficiaries in the US. During the COVID-19 pandemic, the overall TSA hospitalization rate dropped by 14% across racial groups. However, COVID-19 impacted racial groups differently, with the White population experiencing a decrease of 14%, and the non-White population experiencing a decrease of 21%. In particular, Asians and African Americans had a decline of 22% and 25%, respectively. This trend was observed for elective shoulder arthroplasty cases while disparities were less apparent in patients undergoing arthroplasty for proximal humerus fractures.

For a detailed review of the study methods and results, the full report is available here:


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