Most Younger TSA Patients Highly Satisfied, Return to Sport

Nearly all patients age 55 or younger return to sport

More than 96 percent of total shoulder arthroplasty (TSA) patients age 55 and younger returned to sport in less than 7 months after surgery, according to the authors of Scientific Paper 078, “High Satisfaction and Return to Sports after Total Shoulder Arthroplasty: Age 55 And Younger,” presented on Tuesday.

“Young, active shoulder arthroplasty candidates are a unique group of patients,” noted the authors. “They not only demand longevity and improved function, they also desire a return to physical activities.”

This retrospective review involved 59 patients (61 shoulders) who underwent anatomic TSA at a single institution. Patients older than age 55 at the time of surgery and those with less than 2 years of follow-up were excluded. All patients had end-stage osteoarthritis (OA) with significant glenohumeral joint space narrowing. Final follow-up consisted of a patient-reported sports questionnaire and American Shoulder and Elbow Surgeons (ASES) and visual analog scale (VAS) scores.

According to the authors, “Return-to-sports is becoming an important indicator of surgical success.” Their findings demonstrate, they say, that “TSA can provide the ability to return to athletics with minimal complications compared to other surgical alternatives in this unique population.”

Study description
Using an institutional shoulder arthroplasty registry, the authors identified patients who underwent TSA from 2000 to 2014. Surgeries were performed by six different surgeons. All patients received the same implant and all procedures used a delto-pectoral approach. Of the 70 patients who met the initial criteria, 8 were lost to follow-up and 3 declined to participate, leaving 59 patients (39 males and 20 females; average age: 48.9 years; range: 25 years to 55 years). Two patients had bilateral TSA; surgeries were treated separately in the analysis, except where necessary to report by patient numbers.

“Patients were encouraged to return to previous recreational activities as they wished. The limitations imposed were no heavy weightlifting and avoiding contact sports,” noted the authors.

Sports were categorized by the amount of upper extremity use and level of demand (Table 1). Fitness sports were defined as lightweight training or resistance bands and gym attendance greater than 3 hours per week. Outdoor sports were defined as biweekly participation in at least one of the following activities: hunting, fishing, shooting, boating, and/or horseback riding. Starting a new sport postoperatively was not included in the calculations, but “was done to allow for accurate calculation of ‘direct’ rates of return to each individual sport,” they wrote.

Changes in patient-reported outcome measures were assessed using paired student t-tests. Binary logistic regression was used to determine correlation between demographics and return to sport rate. Fisher’s exact test was used to compare discrete variables. All tests were conducted using two-sided hypothesis testing with statistical significance set at P ≤ 0.05.

At final follow-up, four patients had returned to the operating room for revision surgery at an average of 4.2 years (range: 2 months to 6 years). No patients underwent revision surgery for glenoid loosening (one infection, one fractured stem, two dislocations after traumatic falls). However, the researchers noted that the lack of postoperative radiographs, which may have demonstrated subclinical loosening, was a limitation of the study. “As a result,” they wrote, “we cannot comment on wear rates or glenoid loosening that did not require revision surgery.”

Outcomes
“Average ASES scores improved from 39.3 to 88.4 (P < 0.001) and average VAS scores improved from 5.6 to 0.91 (P < 0.001),” noted the authors. Nearly all (96.4 percent) returned to one or more sports postoperatively, at an average 6.7 months after surgery (range: 1.5 months to 12 months). However, there was a slight decline in the average number of sports, from 2.5 preoperatively to 2.1 postoperatively. Patients spent an average of 3.2 hours per week in sport participation.

Nearly all—96.5 percent of patients—were satisfied to very satisfied with their postoperative ability to play sports. Researchers also found that nearly half (47.4 percent) said their physical fitness improved after surgery. They found no significant difference in rate of return to sport by body mass index, sex, age, preoperative diagnosis, revision status, or dominant extremity.

Return-to-sport rates for the most popular sports ranged from 100 percent among cyclists to 75 percent among basketball players. Researchers also examined the impact of surgery on the dominant/nondominant extremity and return to sport, as well as the return to sport based on the level of demand placed on the upper extremity. This study found a return to high-demand sports of 90.3 percent, and a rate of return to high upper-extremity–use sports of 83.8 percent. “These results demonstrate that younger athletic patients can return to a larger number and higher demand of sport than has been previously described,” say the authors.

“Despite studies favoring TSA with higher rates of return to sports, hemiarthroplasty and other options continue to be suggested when younger athletic patients are involved,” they note. “In patients indicated for shoulder replacement, this study demonstrates good results with anatomic total shoulder replacement in active young patients wishing to return to sporting activities.”                       

Coauthors of Scientific Paper 078, “High Satisfaction and Return to Sports After Total Shoulder Arthroplasty: Age 55 and Younger” are Grant Garcia, MD; Joseph Liu, MD; Alec Sinatro, BA; Hao-Hua Wu, BA; Alexandra C. Wong, BA; David M. Dines, MD; Russell F. Warren, MD; and Lawrence V. Gulotta, MD. Disclosure information on the authors can be accessed at www.aaos.org/disclosure

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