Surgeons who performed fewer than five total shoulder replacements annually had higher complication and revision rates, according to a study in the June 2026 issue of the Journal of Shoulder and Elbow Arthroplasty
Six things to know:
1. Researchers used data from PubMed, Cochrane, and Google Scholar were queried through December 2025. Five thresholds of cases per year were established: five cases, 10 cases, 14 cases, 20 cases and 25 to 28 cases.
2. Eight studies with 332,542 patients were included. The review found surgeons performing five cases per year and 25 to 28 cases per year as the breakpoints where outcomes risk diverges significantly between lower- and higher-volume surgeons. These may represent low-to-medium and medium-to-high volume boundaries, respectively.
3. Surgeons performing fewer than 5 shoulder arthroplasties per year had significantly higher odds of both complications and revision surgery.
4. At the 10, 14, and 20 cases per year thresholds, neither complication nor revision rates differed significantly between groups.
5. A second, higher threshold emerged at 25 to 28 cases per year, and surgeons below this mark had significantly greater odds of complication.
6. The study concluded, “This study identified surgeon-volume thresholds for shoulder arthroplasty of 5 cases/yr and 25–28 cases/yr, which may possibly define low-to-medium and medium-to-high-volume thresholds, respectively. Patients treated by surgeons below these thresholds had higher risks of complications and revision compared with those treated by surgeons above the respective thresholds.”
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