The distribution of shoulder replacement among surgeons and hospitals is significantly different than that of hip or knee replacement.

Practice is the repetition of an action to improve its quality. The value of the practice effect is recognized in sports, music, and surgery. The number of times a surgical procedure is performed may have a bearing on how well it is done. We investigated the relative frequency with which hip, knee, and shoulder replacements are performed by individual surgeons. The 1998 database of the Center for Medical Consumers in New York State revealed that over 40% of hip or knee replacement surgeons performed 10 or more replacements. In contrast, only 10 shoulder replacement surgeons (3%) performed 10 or more such procedures; 75% performed only one or two. The distribution of shoulder replacement among surgeons was statistically different than for hip or knee replacement (P <.0001). These findings suggest the need for robust educational programs to minimize the potential adverse effects of low surgeon volume for the patients undergoing these procedures.