title: Trends in total elbow arthroplasty in the Medicare population: a nationwide study of records from 2005 to 2012.
abstract: BACKGROUND
  Utilization of total elbow arthroplasty (TEA) has reportedly increased in recent years. Since the introduction of disease-modifying antirheumatic drugs, there has been a reported decline in its use among rheumatoid patients; yet, the shift in indications for TEA remains unclear. This study evaluated trends in TEA utilization from 2005 to 2012 by analyzing the most common indications within the population of Medicare patients.
  
  
  METHODS
  We performed a retrospective review of a comprehensive Medicare patient population database using the PearlDiver supercomputer (Warsaw, IN, USA) for TEA utilization in rheumatoid arthritis (RA), osteoarthritis (OA), distal humerus fracture (DHF), post-traumatic arthritis (PTA), and distal humerus nonunion (DHNU). Total reported incidence of office visits and TEA utilization for each indication was reviewed.
  
  
  RESULTS
  Utilization of TEA remained unchanged (P = .9530) despite a growing Medicare population (P = .0201). There was a significant decline in annual TEA utilization for RA (P = .002) and DHNU (P = .003). No significant change was found in TEA use for DHF, OA, and PTA. A significant increase was noted in total visits coded for OA, RA, and DHNU (P < .001). A significant, strong negative correlation was found for office visit coding and TEA use in RA (r = -0.850; P = .008) and DHNU (r = -0.902; P = .002).
  
  
  CONCLUSIONS
  From 2005 to 2012, utilization rates of TEA in the Medicare population remained constant. Despite increases in office visits, TEA use for RA and DHNU has declined, likely secondary to improved medical management with disease-modifying antirheumatic drugs and the surgeon's comfort with improved fracture fixation options.
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Triplet
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kurowicki
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Enesi
authors.initials: E
authors.lastname: Momoh
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Tsun Yee
authors.initials: TY
authors.lastname: Law
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Niedzielak
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA. Electronic address: jonlevy123@yahoo.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
mesh_terms: D000368:Aged; D001168:Arthritis / Q000601:surgery; D057929:Arthroplasty, Replacement, Elbow / Q000706:statistics & numerical data*; D004551:Elbow Joint / Q000601:surgery; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D006278:Medicare; D009819:Office Visits / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Total elbow arthroplasty; distal humeral nonunion; distal humerus fracture; osteoarthritis of the elbow; post-traumatic arthritis; rheumatoid arthritis