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Return to sports possible after total shoulder arthroplasty
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KEYSTONE, Colo. – It is more likely than not that active individuals can return to their preoperative level of sports participation following total shoulder arthroplasty, according to a study presented here.
“Approximately 94% of patients will return to sports, and 86% will return to their preoperative sport -- 80% at the preoperative intensity,” Hussein Elkousy, MD, said at the American Society for Sports Medicine 2009 Annual Meeting. “Unrestricted activity can be allowed at 6 months, and low-impact low sports are suggested.
“Return to sport may become a benchmark of these arthroplasty surgeries,” he said.
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To assess activity levels following total shoulder arthroplasty (TSA), Elkousy and colleagues sent questionnaires to 304 patients who received unconstrained TSA; 165 questionnaires were returned and 87 of those patients indicated that they regularly participated in sports.
The average age was 58.5 years and the minimum follow-up was 1 year. “Preoperative diagnosis was commonly osteoarthritis, but we also saw rheumatoid arthritis and osteonecrosis,” he said.
The patients received the same prosthesis, which had an anatomic stem and a cemented all-polyethylene glenoid component. All patients received a tenotomy or tenodesis procedure.
“Rehabilitation involved light swim at 1 to 2 weeks, active external rotation at 4 weeks, water therapy at 5 to 8 weeks, and unrestricted activity beyond 6 months,” Elkousy said. “Restricted behavior before 6 months included putting, half-swing golf shots from the tee at 3 months and full swing at 4 months.”
The preoperative sports that patients participated in included walking, hunting and fishing, golf, swimming, cycling, aerobics, tennis, jogging and waterskiing.
“At minimum 1 year follow-up, 94.4% said they returned to the sport, with 86% returning to the sport they played preoperatively, and 80% who did return reported the same intensity they had preoperatively,” Elkousy said.
“In terms of postoperative pain, 74% reported no postoperative pain with sports participation, 75% reported no pain after sports participation and 82% reported using no pain medication for any pain related to sport participation,” he added.
In a discussion following Elkousy’s presentation, session moderator William N. Levine, MD, commented, “The subscapularis function is critical in trying to understand if the 80% [return-to-same-intensity rate] would be higher. We know that if they are having subscapularis failures, that can compromise their function. I would encourage you to not just do a sports participation study, but to actually quantitate their subscapularis function.”
Reference:
- Drake G, Gibson V, Elkousy H, et al. Resuming sports after total shoulder arthroplasty – Is it viable? Presented at the American Society for Sports Medicine 2009 Annual Meeting. July 9-12, 2009. Keystone, Colo.