Rising Revision Burden in Total Wrist Arthroplasty: National Medicare Trends and Projections to 2060.

Total wrist arthroplasty (TWA) is an alternative to arthrodesis for end-stage wrist arthritis, offering preserved wrist motion and functional improvement. Historically limited by high complication and revision rates, TWA has seen renewed interest with advances in implant design and expanding indications beyond rheumatoid arthritis. The purpose of this study was to analyze national trends in TWA utilization and project future procedure volumes for both primary and revision TWA through 2060 using Medicare data. Procedure volumes for Medicare Part B beneficiaries undergoing primary or revision TWA between 2000 and 2022 were obtained from Centers for Medicare and Medicaid Services Medicare Part B data and adjusted for Medicare Advantage enrollment. Forecasting models were applied to project annual volumes through 2060. From 2000 to 2022, primary TWA increased from 107 to 292 procedures, and revision TWA increased from 47 to 283 procedures. By 2060, annual primary TWA volume is projected to increase to approximately 1040 procedures, while annual revision TWA volume is projected to increase to approximately 3262 procedures. Revision procedures are expected to grow at a faster annual rate (6.6%) compared to primary TWA (3.8%). Total wrist arthroplasty volumes among Medicare beneficiaries are projected to rise through 2060, particularly for revision procedures. These projections may inform future resource planning and highlight the importance of ongoing surveillance of long-term utilization patterns.