Background Shoulder arthroplasty is increasingly common, and the humeral head is routinely sent for pathologic evaluation post-operatively. Prior work has questioned the cost-effectiveness of this practice. The purpose of this study was to assess whether routine gross pathology of the humeral head after shoulder arthroplasty is cost-effective and clinically impactful. Methods Primary total shoulder arthroplasty and hemiarthroplasty cases performed at a single tertiary institution from 2013 to 2024 were reviewed. Surgeon pre-operative diagnoses were compared with gross pathology findings to assess diagnostic agreement and any resulting change in patient care. Pathology costs were estimated using the 2024B Centers for Medicare and Medicaid Services fee schedule. Results A total of 1274 cases met the inclusion criteria. Agreement between surgeon and pathology diagnoses was 95. 6%, with 4. 4% discordance. No discordant findings resulted in altered clinical management. The total pathology cost was 20, 778. 94, averaging 371. 05 per discordant diagnosis. Discussion Surgeon and pathologist diagnoses of humeral head pathology after shoulder arthroplasty show an exceedingly high agreement rate of 95. 6%. Importantly, none of the 56 diagnoses in disagreement led to a change in patient care. Routine gross pathologic evaluation of the humeral head after shoulder arthroplasty shows limited clinical utility and is not cost-effective. Level of Evidence Level IV, Economic analysis.
Nakken et al. (Tue,) studied this question.