Saturday, August 22, 2015

Reverse total shoulder - what about return to sports after surgery?

Patient Activity Levels After Reverse Total Shoulder Arthroplasty. What Are Patients Doing?

These authors reviewed 76 patients with preoperative sporting activity who had a reverse total shoulder (RTSA) at a minimum of one year follow-up. The average follow-up was 31.6 months (12-65 mons) and average age was 74.84 years (49.9 - 92.6 yrs). Preoperative diagnoses were cuff tear arthropathy (55.2%), osteoarthritis (30.9%), proximal humerus fracture (17.1%), and rheumatoid arthritis (5.2%). 73% of the cohort had undergone prior ipsilateral shoulder surgery.

Average VAS pain scores improved from 6.57 to 0.63 (p<0.001). Average ASES scores improved from 34.30 to 81.45 (p<0.001). 85.5% of patients who participated in sports preoperatively returned to at least one sport following RTSA. Average time to full return to sport was 5.3 months. Walking had the highest direct rate of return (85.7%), followed by fitness sports (81.5%), swimming (66.7%), running (57.1%), cycling (50.0%) and golf (50%). Age less than 70 years had significant improvement in rate of return to sports (p<0.002). 41.1% reported improved physical fitness following RTSA. 88.2% felt their sports outcome was good to excellent and 93.4% felt their surgical outcome was good to excellent. The two most commonly reported reasons for not returning to a sport were pain (13.1%) and lack of interest (9.2%). 

Comment: Patients are often eager to know what activities they should resume after any type of shoulder arthroplasty. We have previously posted on this topic. The results from this new report are interesting. We know that even more than an anatomic shoulder arthroplasty, a reverse total shoulder loads the bones of the shoulder in a new way and is substantially more constrained. What we do not know is how the postoperative levels of activity might relate to the long term durability of the arthroplasty. Time will tell.

Here's a post showing a 90+ year old man playing tennis 2.5 years after a reverse total shoulder.


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