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OBJECTIVE
Longitudinal trends in epidemiology and utilization of total shoulder arthroplasty (TSA) have not been previously reported. We evaluated trends in the distribution of age, race, hospital volume and teaching status, outcomes, and indications for TSA during the last decade.

METHODS
TSA cases (n = 12,758) were extracted from the 1990-2000 Nationwide Inpatient Sample databases. TSA trends were obtained for 3 time periods: 1990-1993 (period I), 1994-1997 (period II), and 1998-2000 (period III).

RESULTS
Between 1990 and 2000, there were minor increases in the rate of TSA in most age groups. Ninety-three percent of the patients undergoing TSA in all 3 time periods were white. An increased proportion of patients were operated on in high volume hospitals in period III as compared with period I. Patients discharged to inpatient rehabilitation facilities after surgery had longer lengths of in-hospital stays as compared with those discharged home. Osteoarthritis was diagnosed in an increasing proportion of patients undergoing TSA (56.6% in period I versus 70.9% in period III).

CONCLUSION
There was a minor increase in the rate of TSA, and almost no change in use of TSA by nonwhites from 1990 through 2000. Efforts to understand and narrow this apparent underutilization of TSA among nonwhites are required. Further research should determine whether the observed shift of TSA to high volume centers improves surgical outcomes.