Monday, February 8, 2016

Sports after arthroplasty

Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total shoulder replacement

These authors report on the athletic activities of 102 patients having a reverse total shoulder and 71 having a hemiarthroplasty with a standard head component (shown below)

They included patients playing sports preoperatively with minimum 1-year follow-up.

While they concluded that patients undergoing RTSA can return to sports at rates higher than those undergoing HHA, data from the paper indicate that the results were similar:

Comment: As is the case for most retrospective comparison studies, it is not clear why patients wound up in one treatment group or the other. Clearly some unidentified factors led the surgeon and the patient to select a reverse for some of the patients and a hemiarthroplasty for others. It is possible that these unidentified factors may have had a greater influence on the outcome than which procedure was selected.

In the management of individuals with non-pseudoparalytic rotator cuff tear arthropathy and an intact coracoacromial arch who which to remain physically active, we consider the option of a hemiarthroplasty with a cuff tear arthropathy (CTA) prosthesis (see this link). 

In contrast to the prosthesis used in this study, the CTA has an extended humeral articular surface for articulation and stabilization with the undersurface of the coracoacromial arch. By virtue of being unconstrained, the CTA arthroplasty may have a lower risk of fracture or prosthesis failure than a constrained reverse total shoulder in the event of a fall. See this link.