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Type: Journal article
Title: Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data
Author: Brennan-Olsen, S.
Page, R.
Lane, S.
Lorimer, M.
Buchbinder, R.
Osborne, R.
Pasco, J.
Wluka, A.
Sanders, K.
Ebeling, P.
Graves, S.
Citation: BMC Musculoskeletal Disorders, 2016; 17(1):291-1-291-9
Publisher: BMC
Issue Date: 2016
ISSN: 1471-2474
Statement of
Sharon L. Brennan-Olsen, Richard S. Page, Stephen E. Lane, Michelle Lorimer, Rachelle Buchbinder, Richard H. Osborne, Julie A. Pasco, Anita E. Wluka, Kerrie M. Sanders, Peter R. Ebeling and Stephen E. Graves
Abstract: Background: Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007–11 for all Australians aged ≥40 years. Methods: Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. Results: During 2007–11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Conclusions: Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.
Keywords: Arthroplasty, socioeconomic factors, shoulder joint; geographic locality; Australia
Rights: © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/s12891-016-1134-4
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