Shoulder Replacement Is Medicare's Fastest-Growing Joint Surgery

The newest Medicare Physician Annual Release tells a story that has gone almost entirely uncovered: shoulder replacement is now the fastest-growing major joint surgery in Medicare, and it is not close.

We analyzed every surgeon-level record for the three major joint replacement procedures in the new release and compared them against prior years. Total shoulder replacement volume grew 8.0% in a single year, reaching 63,781 Medicare-billed procedures performed by 2,217 surgeons. Over the past five annual releases, shoulder volume is up 32%. Hip replacement grew a steady 2.1% to 165,559 procedures. Knee replacement, the largest of the three, slipped 1.2% on paper to 298,629.

The growth is even bigger than it looks

Here is the part most coverage of Medicare data misses: these numbers carry a built-in headwind that makes every growth figure an understatement.

The public Medicare physician dataset counts only Original Medicare (fee-for-service) claims. Medicare Advantage patients, now roughly 54% of all Medicare beneficiaries and growing every year, are invisible in this file. That means the visible patient pool shrinks year after year, and any procedure that still shows growth is growing fast enough to overcome a falling denominator.

Shoulder replacement did not just grow 8% in that environment. It added 119 net new surgeons billing the procedure, the only one of the three joints with meaningful surgeon expansion. The American Joint Replacement Registry's most recent annual report points in the same direction, with reverse shoulder arthroplasty repeatedly flagged among the fastest-growing procedures in American orthopedics.

Two forces are widely credited for the trend: reverse total shoulder arthroplasty has expanded the candidate pool to patients with rotator cuff damage who previously had no good implant option, and outcomes for both anatomic and reverse shoulder replacement have improved as the procedure has matured.

No, knee replacement is not declining

A casual reader of the new release might conclude that knee replacement demand is falling. The visible volume dipped 1.2%, and 125 fewer surgeons billed the procedure than the year before. That would be a misread.

Look one level deeper and the picture inverts. The average knee volume per surgeon went up again, from 44.8 to 45.1 procedures, continuing a steady climb from 41.6 five releases ago. Surgeons are not doing fewer knees. Fewer surgeons are visible in the fee-for-service data, while the ones who remain do more each. The decline on paper is the signature of Medicare Advantage migration plus practice consolidation, not of falling demand. Registry data, which counts procedures regardless of payer, shows knee volume still growing nationally.

The same consolidation shows up in every joint. Average hip volume per surgeon has risen from 33.9 to 36.4 over five releases. The number of surgeons performing 100 or more Medicare-billed hip replacements in a year has grown from 130 to 159. Across all three procedures, the top tenth of surgeons by volume perform a remarkably stable 27% to 30% of everything.

One in seven surgeons turned over

One more pattern worth knowing: the surgeon population behind these numbers churns more than most patients would guess. Roughly one in seven surgeons who billed Medicare for hip replacement in the prior release does not appear in the new one, replaced by an almost identical number of newcomers. Knee turnover ran similar, with exits outnumbering entries.

Some of that is retirement and real exits. Some of it is an artifact of how CMS protects patient privacy: any surgeon with 10 or fewer Medicare fee-for-service cases of a procedure in a year is suppressed from the file entirely. Surgeons hovering near that line blink in and out of visibility from year to year. Either way, the practical lesson for patients is the same: a surgeon's track record in this data is strongest where volume is well above the reporting floor, which is exactly where outcomes research says you want to be anyway.

What this means if you need a shoulder replacement

Shoulder replacement's rapid growth cuts two ways for patients. More surgeons are offering it, which improves access. But growth also means more surgeons early on their learning curve, which makes volume-checking more useful for shoulder than for any other joint. The volume-outcome relationship is well documented in shoulder arthroplasty, particularly for reverse procedures.

Our national shoulder replacement rankings list the highest-volume shoulder surgeons in the country, and every state ranking page breaks the same data down locally. Each surgeon profile shows verified Medicare volume against the state and national averages, so you can see exactly where a surgeon sits in the distribution.

How we counted

These figures come from our analysis of the Medicare Physician and Other Practitioners by Provider and Service dataset, the annual public release of surgeon-level Medicare billing. We count HCPCS 23472 (total shoulder arthroplasty, including reverse), 27447 (total knee arthroplasty), and 27130 (total hip arthroplasty).

Three limitations apply to every number above, ours and everyone else's. The data covers Original Medicare only, so each surgeon's count is a floor, not their total practice volume. CMS suppresses any surgeon-procedure combination with 10 or fewer beneficiaries, so the lowest-volume surgeons are not visible. And the data counts services billed, not unique patients. Our full approach is documented on our methodology page.

Sources

1. Centers for Medicare and Medicaid Services, Medicare Physician and Other Practitioners by Provider and Service, annual releases. data.cms.gov
2. CMS, Medicare Physician and Other Practitioners Methodology. data.cms.gov
3. American Academy of Orthopaedic Surgeons, American Joint Replacement Registry Annual Report (12th edition, 2025). aaos.org
4. KFF, Medicare Advantage enrollment analysis, 2024 to 2025. kff.org