Surgical outcome has been linked to frequency of the surgical procedure with increased complications among surgeons with low volume. Shoulder arthroplasty is a relatively low volume procedure compared to hip or knee replacement. A recent papers has shown that in 1999 only 3% of surgeons perform 10 or more shoulder arthroplasties in New York State (Hasan SS et al). We postulated that the situation in England and Wales may be similar and examined data on frequency for shoulder hip and knee arthroplasty.

Hospital Episode Statistics(HES) data for the year April 2002 to April 2003 was analysed for Total hip replacement, Elbow replacement and Total and Hemi- shoulder arthroplasty. Consultant codes were matched for surgical codes for the procedures.

338 (61%) of surgeons doing shoulder arthroplasty performed 2 or less procedures during the study year. 13 surgeons (2.4%) performed more than 20 shoulder arthroplasties. This contrasted with shoulder and knee arthroplasty where volumes per consultant were higher (vide infra).

The majority of surgeons who performed shoulder arthroplasty during the year 2002/2003 did 2 procedures or less. The authors raise concern about the outcome of surgery among surgeons with such low volumes.