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Sports participation after shoulder arthroplasty varies by procedure, patient experience
Magnussen RA. J Shoulder Elbow Surg. [Epub ahead of print]. doi:10.1016/j.jse.2010.07.021.
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A survey of international shoulder surgeons revealed that activity restrictions after shoulder arthroplasty are dependent upon the type of procedure performed and patients’ preoperative sports experience.
For their study, Robert A. Magnussen, MD, and colleagues conducted an online survey of members of the American Shoulder and Elbow Surgeons and the European Society for Surgery of the Shoulder and Elbow. The investigators asked respondents to classify their postoperative recommendations for 37 sports activities after hemiarthroplasty, total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) into one of the following categories:
- allowed;
- allowed with experience;
- not allowed; and
- undecided.
The investigators had a survey response rate of 18% which included 52 European and 47 North American surgeons, according to the study abstract.
The respondents recommended that patients be allowed to participate in nonimpact activities, such as running and walking, after all of the shoulder procedures. The investigators found that sports with light upper extremity involvement were permissible after TSA and hemiarthroplasty. In addition, such activities were allowed after RTSA if the patient had experience in the sport before the procedure.
The survey revealed that sports with the potential for falls, such as soccer, basketball and tennis, were allowed for experienced patients after hemiarthroplasty and TSA. However, the respondents noted that participation in these activities were undecided or not allowed following RTSA. The respondents were undecided in their recommendations for participation in higher-impact sports, like volleyball and weightlifting, following hemiarthroplasty and TSA. These sports were not prohibited after RTSA.
“European surgeons were more conservative than American surgeons in their recommendations after hemiarthroplasty and TSA, but good agreement between the two groups was noted regarding restrictions after TSA,” the investigators wrote in their abstract.
The low response rate would suggest that the results cannot be generalized to the groups surveyed. Selection bias for responders is possible and cannot be excluded. The data presented would only be consider level V data (expert opinion). The responses seem to me to have face validity and seem reasonable.
The question of activity level after surgery would seem to be considered as a risk factor for premature failure of the components and is one of many factors associated with late failure. Without an appropriate study design ,the impression given by these responders cannot be considered anything more than expert opinion. It would be more interesting to present the data in more detail to look and the differences between responders vs. presenting the data for the responses that were in common for the majority of the responders for each type of replacement.
It is not the kind of study that will change clinical practice or any surgeons’ recommendations to their patients.
— Joseph Iannotti, MD, PhD
Orthopedics Today Editorial Board Shoulder & Elbow Section Editor