# Implant prices and physician reimbursement have declined more than total costs and hospital payments in total shoulder arthroplasty

## TL;DR

Shoulder implant prices and surgeon pay have dropped more than overall costs and hospital payments, but patients haven't seen much savings.

## Contribution

First study to compare implant pricing trends with total costs, reimbursements, and patient spending in shoulder surgery.

## Key findings

- Implant prices for TSA dropped by 45.3% for aTSA and 42.9% for rTSA from 2010 to 2022.
- Physician reimbursement fell by 46.4%, while hospital reimbursement and total costs decreased less significantly.
- Patient out-of-pocket costs remained largely unchanged despite implant price reductions.

## Abstract

Total shoulder arthroplasty (TSA) is among the fastest-growing joint replacement procedures in the United States. As bundled payment models and value-based care initiatives expand, surgeons and hospitals face increasing pressure to contain costs. Implants account for a substantial portion of procedural expenses, yet trends in TSA implant pricing relative to total costs, hospital and physician reimbursement, and patient out-of-pocket (OOP) spending remain poorly characterized.

Implant prices for anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) from 2010 to 2022 were obtained from the largest publicly available implant registry, Orthopedic Network News. Cost, reimbursement, and patient OOP spending data were sourced from a commercial insurance claims database. All costs, reimbursements, and prices were adjusted for inflation. Trends were analyzed using linear regressions.

A total of 59,442 TSA procedures were included. The average implant price was $5,928 for aTSA and $8,720 for rTSA. Between 2010 and 2022, implant prices declined substantially for both aTSA (−45.3%, P < .001) and rTSA (−42.9%, P < .001). Physician reimbursement decreased by 46.4% (P < .001). In contrast, overall costs and hospital reimbursement decreased more modestly (−32.3%, P = .06; −29.8%, P = .09, respectively). Patient OOP costs remained relatively unchanged (−13.9%, P = .25).

Although implant prices have decreased substantially over time, the financial benefit has not been realized by patients or surgeons. This is the first study to contextualize implant cost trends alongside total costs, hospital reimbursement, physician reimbursement, and OOP patient expenses in TSA, highlighting persistent gaps in cost transparency. In an era of increasing TSA volumes and growing cost-control pressures, these findings underscore the need for surgeon awareness of implant costs, which will be particularly important in guiding future changes to clinical practice, payment models, and policy.