Wrist Arthroscopy in South Korea: Utilization, Disparities, and Complications from an 11-Year Nationwide Cohort

Abstract

Background: Wrist arthroscopy has evolved significantly as a minimally invasive technique for both diagnostic and therapeutic purposes. However, epidemiologic data on its nationwide use remain scarce, particularly for small joints like the wrist. Given its increasing adoption and technical complexity, understanding population-level trends in wrist arthroscopy is essential to inform clinical practice, policy planning, and surgical education. Methods: We conducted a retrospective nationwide analysis of wrist arthroscopic procedures performed in South Korea between 2013 and 2023, using National Health Insurance claims data. Procedures were categorized into diagnostic arthroscopy (P1), partial joint debridement or synovectomy (P2), and ligament or tendon reconstruction (P3) based on administrative billing codes. Trends were analyzed by year, age group, sex, income ventile, and region, with incidence rates calculated per 100,000 persons. In addition, postoperative complications such as nerve injury, extensor tendon injury, infection, and complex regional pain syndrome were identified using diagnosis codes within specified postoperative periods. Results: A total of 48,962 wrist arthroscopic procedures were identified between 2013 and 2023. The incidence increased from 6.43 to 10.98 per 100,000 persons, with a temporary decline during the coronavirus disease 2019 (COVID-19) pandemic. P2 remained most common, but the share of P3 rose markedly. The 50-59-year age group consistently accounted for the highest total number of procedures across the study period. The 30-39-year group showed the most prominent relative increase in P2 and P3 cases. The 20-29-year group recorded the highest rate of P3 procedures in 2023. Women consistently underwent more procedures, though men showed greater growth in P3. Regional variation was observed; however, contrary to expectation, Seoul and the metropolitan areas were not among the highest-incidence regions. No income-based disparity was identified, and complications were uncommon overall. Conclusions: This nationwide 11-year analysis demonstrates that wrist arthroscopy in South Korea has steadily increased, with a growing trend toward complex reconstructive procedures. Despite regional variation, no income-based disparity was observed, and overall complication rates remained low, although postoperative infection was observed somewhat more frequently than reported after larger-joint arthroscopy, supporting both the accessibility and safety of wrist arthroscopy in routine clinical practice.