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Sachinis NP, Yiannakopoulos CK, Berthold DP, Franz A, Beitzel K. Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review. Shoulder Elbow 2024; 16:214-227. [PMID: 38655406 PMCID: PMC11034463 DOI: 10.1177/17585732221144007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 04/26/2024]
Abstract
Background There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation. Methods This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. Results Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10-145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73-136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group. Discussion Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K Yiannakopoulos
- IASO Hospital, Athens, Greece
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Kim HG, Kim SH, Kim SC, Park JH, Kim JS, Kim BT, Lee SM, Yoo JC. Return to Sports Activity After Reverse Total Shoulder Arthroplasty. Orthop J Sports Med 2023; 11:23259671231208959. [PMID: 38035211 PMCID: PMC10686035 DOI: 10.1177/23259671231208959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 12/02/2023] Open
Abstract
Background There are little published data on return to sports (RTS) after reverse total shoulder arthroplasty (RTSA). Purpose To (1) determine the rate and timing of RTS after RTSA in an Asian population, (2) analyze predictive factors for RTS, and (3) determine the relationship between RTS after RTSA and clinical/radiological outcomes. Study Design Case-control study; Level of evidence, 3. Methods A retrospective review was performed on consecutive patients with diagnosis of irreparable rotator cuff tear (RCT), cuff tear arthropathy (CTA), or degenerative osteoarthritis who underwent RTSA between May 2017 and May 2020. Included were patients who played sports preoperatively in ≤3 years and had ≥2-year follow-up. Patients were divided into 2 groups based on responses to a telephone survey about RTS after RTSA: those who returned to sports (group A) and those who did not (group B). Patient characteristics, pre- and postoperative clinical features and functional scores, and radiologic outcomes (acromial fracture, scapular notching, heterotopic ossification, and loosening of humeral and glenoid component) were compared between the groups. Results Of 59 eligible patients, 44 patients (28 in group A, 16 in group B) were included. The RTS rate after RTSA was 63.6%, and the mean RTS time was 9.1 months (range, 3-36 months). There was a significant group difference in body mass index (BMI) (group A, 24.3 ± 2.1; group B, 27.1 ± 4.4; P = .01) and preoperative diagnosis (CTA/irreparable RCT/degenerative osteoarthritis diagnoses: group A, 13/12/3; group B, 3/6/7; P = .03). Patients in group A showed significantly higher forward flexion (P = .03) and higher Simple Shoulder Test score (P = .02) than group B at final clinical follow-up. No significant difference in radiological outcomes was found between the groups. Conclusion Patients with a low BMI and those diagnosed with CTA or irreparable RCT were found to have better RTS rates after undergoing RTSA, and forward flexion and Simple Shoulder Test scores at final follow-up were significantly higher in the RTS group, with no significant differences in complications.
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Affiliation(s)
- Hyun Gon Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Kim
- Department of Orthopaedic Surgery, Saeroun Hospital, Seoul, Republic of Korea
| | - Su Cheol Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hun Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Soo Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Taek Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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6
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Franceschetti E, Gregori P, Giurazza G, Papalia G, Caraffa A, Papalia R. Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2023; 7:24715492231152143. [PMID: 36714423 PMCID: PMC9875319 DOI: 10.1177/24715492231152143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis. Results A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively. Conclusions Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients. Level of Evidence IV.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giancarlo Giurazza
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Auro Caraffa
- Department of Orthopaedic and Trauma Surgery, Perugia hospital, Perugia, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Jan K, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to Sport Following Distal Triceps Repair. J Hand Surg Am 2022; 48:507.e1-507.e8. [PMID: 35074247 DOI: 10.1016/j.jhsa.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/18/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport. METHODS Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation. RESULTS Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up. CONCLUSIONS Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA
| | | | - Kyleen Jan
- School of Medicine, University of Illinois, Chicago, IL
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL
| | - Robert W Wysocki
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
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Franceschetti E, Giovannetti de Sanctis E, Gregori P, Palumbo A, Paciotti M, Di Giacomo G, Franceschi F. Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review. J ISAKOS 2021; 6:363-366. [PMID: 34794965 DOI: 10.1136/jisakos-2020-000581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
IMPORTANCE One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. OBJECTIVE The aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance. EVIDENCE REVIEW The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA. FINDINGS A total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33-88 years) and 3.6 years (range 1-9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases. CONCLUSIONS AND RELEVANCE Based on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edoardo Giovannetti de Sanctis
- Department of Orthopaedic and Traumatology, Policlinico Agostino Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
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Küffer J, Taha ME, Hoffmeyer P, Cunningham G. Return to sport after shoulder arthroplasty: a systematic review. EFORT Open Rev 2021; 6:771-778. [PMID: 34667648 PMCID: PMC8489481 DOI: 10.1302/2058-5241.6.200147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The main goal of this study was to determine the rate of return to sport (RTS) after shoulder arthroplasty. A systematic review of the literature was performed using the PRISMA guidelines. All clinical studies written in English, French or German, with a level of evidence of 1 to 4, and evaluating return to sport after shoulder arthroplasty, were included. A total of 23 studies were included with 2199 patients who underwent hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RSA). Mean age was 68 years (range 18 to 92.6), sex ratio (male:female) was 1:1.5. The surgery was performed on the non-dominant/dominant shoulder in 1:1.8 cases. The mean follow-up was 4.2 years. The rate of RTS was 75.5% with a mean time of 7 months. It was 77.4% for TSA, 75% for RSA and 71.2% for HA (P = non-significant). RTS after shoulder arthroplasty is high, regardless the type of arthroplasty, with a trend for a higher rate after TSA. Patients who were able to maintain a sport activity preoperatively had a greater chance of RTS after arthroplasty. Failure to RTS seems to be mostly linked to the severity of the underlying condition and length of preoperative disability.
Cite this article: EFORT Open Rev 2021;6:771-778. DOI: 10.1302/2058-5241.6.200147
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Affiliation(s)
| | - Mohy E Taha
- Division of Orthopaedics and Trauma Surgery, Basel University Hospital, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland
| | - Gregory Cunningham
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland.,Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
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Gowd AK, Liu JN, Maheshwer B, Garcia GH, Beck EC, Cohen MS, Nicholson GP, Cole BJ, Verma NN. Return to sport and weightlifting analysis following distal biceps tendon repair. J Shoulder Elbow Surg 2021; 30:2097-2104. [PMID: 33667641 DOI: 10.1016/j.jse.2021.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the distal biceps tendon is an increasingly frequent injury sustained predominantly by middle-aged men. Despite the prevalence of sport in this age group, little is known regarding return to sport outcomes following surgery. METHODS Patients undergoing distal biceps tendon repair (DBR) between January 2015 and January 2017 were contacted electronically via e-mail and via telephone to administer a previously validated and standard return to sport survey. Patients self-reported preinjury and current level of sport and activity as well as preinjury and current level of select weightlifts. RESULTS A total of 77 of 124 patients were available for follow-up (62.1%). Of these patients, 61 endorsed preoperative sport and were included for analysis. Average follow-up was 38.7 ± 6.7 months. The mean age at surgery was 47.5 ± 8.8 years, and the mean body mass index was 30.3 ± 5.1. The dominant side was affected in 25 of 61 cases. Of the 61 included patients, 57 (93.4%) were able to return to sport at any level (lower, same, or higher intensity than preinjury activity level). Forty of the patients (65.6%) were able to return to sport at same or higher intensity. Mean time to return to sport was 6.0 ± 2.8 months. Days from injury to surgery (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998-0.999), suture anchor fixation in comparison to suture button (OR 0.602, 95% CI 0.427-0.850), and dominant-side surgery (OR 0.749, 95% CI 0.582-0.963) were associated with a decreased likelihood to return to sport at same or higher level of duty. Single-sided incision in comparison to double (OR 5.209, 95% CI 1.239-20.903) and dominant-side surgery (OR 6.370, 95% CI 1.639-24.762) were associated with increased duration to return to sport. CONCLUSION Distal biceps tendon rupture is a significant injury; however, patients can expect high levels of return to sport following DBR with some residual impairment compared with baseline. It is important to counsel patients on their expectations while taking into account the results of this study: that there will be a small but appreciable decrease in strength compared with preinjury levels.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | - Edward C Beck
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mark S Cohen
- Rush University Medical Center, Chicago, IL, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
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11
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St Pierre P, Millett PJ, Abboud JA, Cordasco FA, Cuff DJ, Dines DM, Dornan GJ, Duralde XA, Galatz LM, Jobin CM, Kuhn JE, Levine WN, Levy JC, Mighell MA, Provencher MT, Rakowski DR, Tibone JE, Tokish JM. Consensus statement on the treatment of massive irreparable rotator cuff tears: a Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg 2021; 30:1977-1989. [PMID: 34116192 DOI: 10.1016/j.jse.2021.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of massive irreparable rotator cuff tears (MIRCTs) remains controversial owing to variability in patient features and outcomes contributing to a lack of unanimity in treatment recommendations. The purpose of this study was to implement the Delphi process using experts from the Neer Circle of the American Shoulder and Elbow Surgeons to determine areas of consensus regarding treatment options for a variety of MIRCTs. METHODS A panel of 120 shoulder surgeons were sent a survey regarding MIRCT treatments including arthroscopic débridement and partial cuff repair, graft augmentation, reverse shoulder arthroplasty (RSA), superior capsular reconstruction (SCR), and tendon transfer. An iterative Delphi process was then conducted with a first-round questionnaire consisting of 13 patient factors with the option for open-ended responses to identify important features influencing the treatment of MIRCTs. The second-round survey sought to determine the importance of patient factors related to the 6 included treatment options. A third-round survey asked participants to classify treatment options for 60 MIRCT patient scenarios as either preferred treatment, acceptable treatment, not acceptable/contraindicated, or unsure/no opinion. Patient scenarios were declared to achieve consensus for the preferred and not acceptable/contraindicated categories when at least 80% of the survey respondents agreed on a response, and a 90% threshold was required for the acceptable treatment category, defined by an acceptable treatment or preferred treatment response. RESULTS Seventy-two members agreed to participate and were deemed to have the requisite expertise to contribute based on their survey responses regarding clinical practice and patient volume. There were 20 clinical scenarios that reached 90% consensus as an acceptable treatment, with RSA selected for 18 scenarios and arthroscopic débridement and/or partial repair selected for 2. RSA was selected as the singular preferred treatment option in 8 scenarios. Not acceptable/contraindicated treatment options reached consensus in 8 scenarios, of which, 4 related to SCR, 3 related to RSA, and 1 related to partial repair with graft augmentation. CONCLUSION This Delphi process exhibited significant consensus regarding RSA as a preferred treatment strategy in older patients with pseudoparesis, an irreparable subscapularis, and dynamic instability. In addition, the process identified certain unacceptable treatments for MIRCTs such as SCR in older patients with pseudoparesis and an irreparable subscapularis or RSA in young patients with an intact or reparable subscapularis without pseudoparesis or dynamic instability. The publication of these scenarios and areas of consensus may serve as a useful guide for practitioners in the management of MIRCTs.
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Affiliation(s)
- Patrick St Pierre
- Eisenhower Health, Desert Orthopedic Center, Rancho Mirage, CA, USA.
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Joseph A Abboud
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Frank A Cordasco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA
| | - David M Dines
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Leesa M Galatz
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - John E Kuhn
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - James E Tibone
- Kerlan-Jobe Orthopedic Clinic, Keck USC School of Medicine, Los Angeles, CA, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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12
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Tangtiphaiboontana J, Mara KC, Jensen AR, Camp CL, Morrey ME, Sanchez-Sotelo J. Return to Sports After Primary Reverse Shoulder Arthroplasty: Outcomes at Mean 4-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211012393. [PMID: 34179208 PMCID: PMC8202274 DOI: 10.1177/23259671211012393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: With the expanding use of reverse shoulder arthroplasty (RSA) to treat various shoulder conditions, there has been a rise in the number of RSAs performed, especially in physically active patients. Limited information regarding sports after RSA is available to properly counsel patients on postoperative expectations. Purpose: To assess the rate of return to sports as well as the ability to return to the same level of preoperative intensity, frequency, and duration of sport after primary RSA. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of patients who underwent primary RSA at our institution between 2014 and 2016. Shoulder motion, Subjective Shoulder Value score, American Shoulder and Elbow Surgeons score, pre- and postoperative sports activities, and barriers to return to sport were assessed in 109 patients after RSA (93 patients with unilateral RSA and 16 patients with bilateral RSA). The mean age at the time of surgery was 70 years (range, 34-86 years), with a mean follow-up of 3.9 years (range, 2-12 years). Results: The mean rate of return to sports was 70.1% (range, 0%-100%). There was no difference in return to sports between those with uni- and bilateral RSA (P = .64). Fishing, swimming, elliptical/treadmill, and hunting were the most common sports after RSA with return rates of 91%, 73%, 86%, and 82% respectively. A majority of patients returned to the same level of preoperative intensity, frequency, and duration for all sports except for climbing and swimming. There was a lower mean rate of return for high-demand sports (62.9%) compared with low- and medium-demand sports (76.7%) (P = .005). The most common reasons for inability to return to sports included limited motion, fear of injury, and weakness. Conclusion: Patients who had undergone primary uni- or bilateral RSA reported a 70.1% rate of return to sports with maintenance of the same level of intensity, duration, and frequency of preoperative sport participation. Rates of return to high-demand sports were lower than low- and medium-demand sports. Patients also had difficulty returning to overhead sports.
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Affiliation(s)
| | - Kristin C Mara
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew R Jensen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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13
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Salem HS, Park DH, Thon SG, Bravman JT, Seidl AJ, McCarty EC, Frank RM. Return to Golf After Shoulder Arthroplasty: A Systematic Review. Am J Sports Med 2021; 49:1109-1115. [PMID: 32678680 DOI: 10.1177/0363546520923070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of golfers aged ≥65 years has increased in recent years, and shoulder arthritis is prevalent in this age group. Guidelines for return to golf (RTG) after shoulder arthroplasty have not been fully established. PURPOSE To review the data available in the current literature on RTG after shoulder arthroplasty. STUDY DESIGN Systematic review. METHODS A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. Two independent reviewers searched PubMed, Embase, and the Cochrane Library using the terms "shoulder,""arthroplasty,""replacement," and "golf." The authors sought to include all studies investigating RTG after total shoulder arthroplasty (TSA), shoulder hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). Outcomes of interest included indications for shoulder arthroplasty, surgical technique, rehabilitation protocol, amount of time between surgery and resumption of golf activity, and patient-reported outcome measures. RESULTS A total of 10 studies were included, 2 of which reported on golf performance after shoulder arthroplasty. The other 8 studies described return to sports after shoulder arthroplasty with golf-specific data for our analysis. Three studies that included patients who underwent TSA reported RTG rates ranging from 89% to 100% after mean follow-up periods of 5.1 to 8.4 months. Two studies included patients who underwent TSA and HA and reported RTG rates of 77% and 100% after mean intervals of 5.8 and 4.5 months, respectively. Two studies included patients who underwent RSA, with RTG rates of 50% and 79% after mean postoperative intervals of 5.3 and 6 months, respectively. One study included only patients undergoing HA, with an RTG rate of 54% and a mean RTG time of 6.5 months. Varying surgical procedures and baseline patient characteristics precluded our ability to draw conclusions regarding surgical technique, rehabilitation protocol, or patient-reported outcome measures among studies reporting these data. CONCLUSION Most patients who undergo a shoulder arthroplasty procedure can expect to resume playing golf approximately 6 months after the index procedure. The rate of return may be lower after RSA and HA as compared with anatomic TSA. The data presented in our review can help physicians counsel patients who wish to continue golf participation after a shoulder arthroplasty procedure.
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Affiliation(s)
- Hytham S Salem
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Do H Park
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Stephen G Thon
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Adam J Seidl
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Eric C McCarty
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rachel M Frank
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
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Werner BC, Kew ME, Brockmeier SF, Gowd AK, Romeo AA, Agarwalla A. Postoperative opioid usage is greater following hemiarthroplasty compared to reverse total shoulder arthroplasty for proximal humerus fractures. SEMINARS IN ARTHROPLASTY: JSES 2020. [DOI: 10.1053/j.sart.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Liu JN, Agarwalla A, Christian DR, Garcia GH, Redondo ML, Yanke AB, Cole BJ. Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation. Am J Sports Med 2020; 48:1945-1952. [PMID: 32459515 DOI: 10.1177/0363546520920626] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. PURPOSE To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. STUDY DESIGN Case series; level of evidence, 4. METHODS Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. RESULTS Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). CONCLUSION In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.
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Affiliation(s)
- Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California, USA
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - David R Christian
- Department of Orthopedic Surgery, Northwestern University Medical Center, Chicago, Illinois, USA
| | | | - Michael L Redondo
- Department of Orthopedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Adam B Yanke
- Seattle Orthopaedic Center, Seattle, Washington, USA
| | - Brian J Cole
- Seattle Orthopaedic Center, Seattle, Washington, USA
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16
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Cvetanovich GL, Naylor AJ, O'Brien MC, Waterman BR, Garcia GH, Nicholson GP. Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity. J Shoulder Elbow Surg 2020; 29:1188-1196. [PMID: 31899092 DOI: 10.1016/j.jse.2019.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biomechanical studies show that inlay glenoid components in total shoulder arthroplasty (TSA) can reduce edge loading and opposite-edge lift-off forces with humeral translation compared with onlay glenoids. However, clinical data for these implants are lacking. We report clinical outcomes and return to activities after anatomic TSA with an inlay glenoid component and a stemless ovoid humeral head in an active, young patient population. METHODS A retrospective review of TSA with an inlay glenoid component and an ovoid humeral head component was performed for 27 shoulders. Patients were evaluated with patient-reported outcome measures, range of motion, and radiographs. Return to occupational and sporting activity, complications, and reoperations were analyzed. RESULTS A total of 27 shoulders were available for minimum 2-year follow-up. Age averaged 52.1 years, and 92.6% of shoulders were in male patients. The preoperative Walch grade was A1 or A2 in 15 shoulders (55%), B1 in 8 (30%), and B2 in 4 (15%). Patients showed significant improvements in patient-reported outcome measures, active forward flexion, and external rotation (P < .001) with no reoperations. At an average of 3.7 months, the rate of return to work was 92.6%, with 76.0% of those patients returning to their preoperative occupational demand level. At an average of 9.1 months, 75% of patients who responded to our custom survey returned to sport, with 50% achieving the same level or a higher level of sporting activity. Annual postoperative radiographs revealed no inlay component loosening. CONCLUSION Anatomic TSA with an inlay glenoid coupled with a stemless ovoid humeral head in an active population resulted in improved clinical outcomes, no reoperations or radiographic loosening, and a high rate of return to activity at shorter-term follow-up.
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Affiliation(s)
- Gregory L Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amanda J Naylor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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17
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Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9051576. [PMID: 32456117 PMCID: PMC7291255 DOI: 10.3390/jcm9051576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/10/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of postoperative rehabilitation protocols. A systematic search in Pubmed-Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that evaluated the rate of return to sport after RTSA or ATSA. Six retrospective studies, five case series, and one prospective cohort study were included in this review. The overall rate of return to sport was 82% (95% CI 0.76–0.88, p < 0.01). Patients undergoing ATSA returned at a higher rate (90%) (95% CI 0.80–0.99, p < 0.01) compared to RTSA (77%) (95% CI 0.69–0.85, p < 0.01). Moreover, the results showed that patients returned to sport at the same or a higher level in 75% of cases. Swimming had the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%). Thus, RTSA and ATSA are effective to guarantee a significative rate of return to sport in elderly patients. A slightly higher rate was found for the anatomic implant.
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18
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Liu JN, Agarwalla A, Garcia GH, Christian DR, Redondo ML, Yanke AB, Cole BJ. Return to sport following isolated opening wedge high tibial osteotomy. Knee 2019; 26:1306-1312. [PMID: 31439368 DOI: 10.1016/j.knee.2019.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/03/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purposes of the study are as follows: (1) examine the timeline of return to sport (RTS) following isolated high tibial osteotomy (HTO), (2) evaluate the degree of participation and function upon RTS and (3) identify reasons that patients do not return or discontinue participation in sport activity. METHODS Patients undergoing isolated HTO were reviewed retrospectively at a minimum of two years post-operatively. Patients completed a subjective sports questionnaire, a visual analog scale for pain, Single Assessment Numerical Evaluation, and a satisfaction questionnaire. RESULTS Thirty-eight patients (70.4%) were included at an average of 9.0 ± 3.3 years. Thirty-four patients (average age 42.7 ± 7.2 years, 90.0% with a Kellgren-Lawrence grade of III/IV) participated in sports within three years prior to surgery. Eighteen patients (52.9%) returned to the operating room by the time of final follow-up, including 13 patients (38.2%) who underwent salvage arthroplasty by 6.1 ± 3.6 years following HTO. Thirty patients (88.2%) returned to ≥1 sport at an average of 7.5 ± 5.0 months; however only 41.2% were able to return to preinjury level of participation. CONCLUSIONS In patients with medial osteoarthritis and varus deformity, isolated high tibial osteotomy provides a high rate (88.2%) of return to sport by 7.5 months postoperatively, yet only a fraction of patients returned to their preinjury level. HTO is not a definitive treatment option as nearly 40% of patients underwent knee arthroplasty by 6.1 years post-operatively. Patient expectations regarding return to sport can be appropriately managed with adequate preoperative patient education. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States of America.
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, United States of America
| | - Grant H Garcia
- Seattle Orthopaedic Center, Seattle, WA, United States of America
| | - David R Christian
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, United States of America
| | - Michael L Redondo
- Department of Orthopedic Surgery, University of Illinois Medical Center, Chicago, IL, United States of America
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, United States of America.
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, United States of America.
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Ngan A, Xiao W, Curran PF, Tseng WJ, Hung LW, Nguyen C, Matthew R, Ma B, Lotz J, Feeley BT. Functional workspace and patient-reported outcomes improve after reverse and total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:2121-2127. [PMID: 31281000 DOI: 10.1016/j.jse.2019.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Low-cost motion analysis systems (LCMASs) have emerged as easy and practical methods to measure the functional workspace (FWS). Thus, we ventured to apply an LCMAS, the Kinect2 gaming camera, to evaluate the FWS in patients with shoulder osteoarthritis (OA) and patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). METHODS A cross-sectional study of participants with OA (n = 53), TSA (n = 70), and RTSA (n = 34) was performed. The FWS as measured by an LCMAS, the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score, and the Patient-Reported Outcomes Measurement Information System (PROMIS) score were collected. For participants who underwent TSA or RTSA, the FWS was evaluated at 6, 12, and 24 months postoperatively. The correlation of the FWS with the ASES score and PROMIS score was determined. Significance was set at P < .05. RESULTS Patients who underwent TSA or RTSA had a significantly higher FWS than patients with shoulder OA at almost all time points. Patients who underwent TSA had a significantly higher FWS than patients who underwent RTSA at 24 months after surgery. PROMIS and ASES scores showed strong correlations with the FWS in patients who underwent TSA (R = 0.75 [P < .001] and R = 0.83 [P < .001], respectively) and RTSA (R = 0.84 [P < .001] and R = 0.73 [P < .001], respectively). CONCLUSION The FWS measured by an LCMAS is an easy and low-cost method to quantify the reachable space of the hand in patients and shows strong correlations with patient-reported outcome measures. This may be a useful tool to assess upper-extremity range of motion before and after shoulder arthroplasty.
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Affiliation(s)
- Alex Ngan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Weiyuan Xiao
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick F Curran
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Wo Jan Tseng
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Li Wei Hung
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Chantal Nguyen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Robert Matthew
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Liu JN, Agarwalla A, Garcia GH, Christian DR, Gowd AK, Yanke AB, Cole BJ. Return to Sport and Work After High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplant. Arthroscopy 2019; 35:3090-3096. [PMID: 31699261 DOI: 10.1016/j.arthro.2019.05.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE (1) To examine the timeline of return to sport (RTS) and return to work (RTW) after high tibial osteotomy (HTO) with concomitant medial meniscal allograft transplant (MAT), (2) to evaluate the degree of function on RTS and RTW, and (3) to identify reasons patients do not return to sport- or work-related activity. METHODS Patients undergoing HTO plus MAT were reviewed retrospectively at a minimum of 2 years postoperatively. The exclusion criterion was any concomitant procedure except cartilage restoration for focal full-thickness medial femoral condylar defects. Patients completed a subjective sport and work questionnaire, a visual analog scale for pain, the Single Assessment Numeric Evaluation, and a satisfaction questionnaire. RESULTS Twenty-two patients (aged 35.1 ± 8.1 years) were included at 9.3 ± 3.7 years postoperatively. Sixteen patients participated in sports within 3 years before surgery, and 14 patients (87.5%) returned to sport by 9.7 ± 3.8 months postoperatively. Only 7 patients (43.8%) returned to their preinjury status. Eighteen patients were employed within 3 years before surgery, and all patients returned to work; however, only 16 patients (88.9%) returned at the same occupational intensity by 3.1 ± 2.4 months. The rates of RTW for light-, medium-, and heavy-intensity occupations were 100%, 75.0%, and 85.7%, respectively, whereas the duration of RTW was 2.1 months, 2.3 months, and 4.8 months, respectively. Of the patients, 20 (90.9%) reported at least 1 complaint postoperatively, with 13 patients (59.1%) returning to the operating room for recurrent symptoms, including 1 patient who received a knee replacement at 7.75 years postoperatively. CONCLUSIONS In patients with medial meniscal deficiency and varus deformity, HTO plus MAT provided high rates of RTS (87.5%) and RTW (100%) by 9.7 months and 3.1 months, respectively. It is imperative that clinicians manage expectations because patients may RTS and RTW after HTO plus MAT; however, return to high-intensity activities or occupations may be unlikely or delayed. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California, U.S.A
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | | | - David R Christian
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois, U.S.A
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Godin JA, Pogorzelski J, Horan MP, Lacheta L, Hussain ZB, Altintas B, Frangiamore S, Mannava S, Fritz EM, Millett PJ. Impact of Age and Subscapularis Tendon Reparability on Return to Recreational Sports Activities and 2-Year Outcomes After Reverse Total Shoulder Arthroplasty. Orthop J Sports Med 2019; 7:2325967119875461. [PMID: 31663006 PMCID: PMC6792278 DOI: 10.1177/2325967119875461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: As the indications for reverse total shoulder arthroplasty (RTSA) have continued to expand, the average age of patients undergoing RTSA has decreased. Purpose/Hypothesis: The purpose of this study was to report the minimum 2-year outcomes after RTSA and to evaluate the impact of surgical variables on outcomes. We hypothesized that younger patients, patients with larger glenosphere, and patients with irreparable subscapularis tendons would experience worse subjective patient-reported outcome scores (PROS) and that younger patients and those with a reparable subscapularis would demonstrate a higher rate of return to recreational sports activities. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent RTSA by a single surgeon between November 2005 and September 2014 were considered for this study. Patient characteristics, surgical details, PROS, and rates of return to recreational sports activity were prospectively collected and retrospectively reviewed. We assessed correlations between PROS and both patient age and subscapularis reparability. PROS collected included the American Shoulder and Elbow Surgeons (ASES) score, Short Form 12 (SF-12), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Single Assessment Numeric Evaluation (SANE), and postoperative patient satisfaction. Results: A total of 110 patients with an average age of 68.0 years (range, 45-87 years) were included. Minimum 2-year follow-up was obtained in 94 patients (85.4%), with a mean follow-up of 3.6 years (range, 2.0-9.3 years). The subscapularis was reparable in 58 patients (57.4%). All PROS significantly improved from pre- to postoperatively (P < .001). The median patient postoperative satisfaction was 9 out of 10 (range, 1-10). Increasing patient age was correlated with significant improvements in QuickDASH and ASES scores. Postoperatively, 76.1% (67/88) of patients were able to return to recreational sports activity. However, of those who did return, 68.2% indicated that they had to modify their activity in some way. Glenosphere size was not significantly associated with PROS or the rate of return to recreational sports activity, but patients with reparable subscapularis tendons demonstrated higher PROS and return to activity rates. Conclusion: Patients who had a reparable subscapularis tendon showed a significantly higher rate of return to recreational sports activity than patients who had a irreparable subscapularis tendon. Older age was correlated with greater improvement in several, although not all, patient-reported outcome measures. Glenosphere size was not significantly associated with higher PROS or rate of return to recreational sports activity.
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Affiliation(s)
- Jonathan A Godin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Salvatore Frangiamore
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Sandeep Mannava
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Erik M Fritz
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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22
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Garcia GH, Gowd AK, Liu JN, Malaret MR, Cabarcas BC, Romeo AA. Return to Sport Following Hemiarthroplasty With Concentric Reaming Versus Total Shoulder Arthroplasty: A Matched Pair Analysis. Orthopedics 2019; 42:276-284. [PMID: 31269217 DOI: 10.3928/01477447-20190627-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to establish functional outcomes regarding return to sport activity for patients receiving anatomical total shoulder arthroplasty (aTSA) vs the ream and run procedure (hemi RR). Patients who underwent hemi RR and who underwent aTSA with a polyethylene glenoid component for end-stage glenohumeral arthritis were retrospectively identified from 2000 to 2014. Patients were matched regarding age, body mass index, sex, and hand dominance. Patients were surveyed to determine their level of sport and satisfaction after surgery. At a mean follow-up of 69.1±24.8 months, a total of 26 hemi RR and 30 aTSA patients met inclusion/exclusion criteria. Mean±SD age at the time of surgery was 53.0±8.5 years. There was no statistical difference between the two cohorts regarding patients who reported no postoperative problems (69.2% vs 76.7%, P=.529), reoperation (11.5% vs 6.7%, P=.522), return to overall sport (94.4% vs 86.4%, P=.395), return to high-demand upper-extremity sport (92.3% vs 81.3%, P=.390), and return to same or better level of intensity sport (83.3% vs 72.7%, P=.424). Patients returned to sport at a mean of 7.5±5.7 months and 6.2±3.6 months in the hemi RR and aTSA cohorts, respectively (P=.485). Radiographic measurements of medialization (mean, -2.4±5.0 vs -2.2±5.7; P=.913) and postoperative decentering (mean, 3.6%±2.6% vs 4.3%±3.3%; P=.795) were equivalent for the two cohorts. Hemi RR was found to have high and equivalent rates of sporting outcomes, clinical outcomes, and radiographic outcomes compared with aTSA. As appropriately indicated patients are counseled for surgery, realistic expectations regarding sports should be discussed. [Orthopedics. 2019; 42(5):276-284.].
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23
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MacInnes SJ, Mackie KE, Titchener A, Gibbons R, Wang AW. Activity following reverse total shoulder arthroplasty: What should surgeons be advising? Shoulder Elbow 2019; 11:4-15. [PMID: 31447940 PMCID: PMC6688158 DOI: 10.1177/1758573218793648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) is now the most frequently performed form of shoulder arthroplasty. There is currently no consensus on recommended levels of activity and sport following RTSA. The aim of this review is to outline the current evidence and provide a guide for surgeons on what to advise their patients regarding activity level following RTSA. METHODS A systematic review of the literature was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed using the electronic databases PubMed and Medline. Included studies were of level 1 to 4 evidence in the English language evaluating complications and return to sport after RTSA. RESULTS Eleven studies were selected and included a total of 621 patients (67% female) with a mean age of 73 years (range 22-92). All of the included patients participated in sports prior to RTSA. The rate of return to sport ranged from 60 to 86% and varied with the level of sport activity. Mean time to return to sport after surgery varied greatly between studies. CONCLUSIONS Return to sport is tolerated following RTSA; however, studies are short to medium term only and although the reported complication rate is low, the studies did not include radiographic evaluation. Longer term studies with subgroup analysis evaluating common recreational activities after RTSA are required, particularly in the younger population, in order to establish clear post-operative guidelines.
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Affiliation(s)
| | | | | | | | - Allan W Wang
- Sir Charles Gairdner Hospital, Nedlands,
Australia,Department of Surgery, University of
Western Australia, Nedlands, Australia,Allan W Wang, Department of Orthopaedics,
Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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24
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Results of total shoulder arthroplasty in patients aged 55 years or younger versus those older than 55 years: an analysis of 1135 patients with over 2 years of follow-up. J Shoulder Elbow Surg 2019; 28:861-868. [PMID: 30591214 DOI: 10.1016/j.jse.2018.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The results of anatomic total shoulder arthroplasty (TSA) in younger patients have not been clearly elucidated. The purpose of this study was to compare early outcomes after TSA in patients aged 55 years or younger versus patients older than 55 years. METHODS A total of 1135 patients who were treated with TSA for glenohumeral arthritis and had a mean follow-up period of over 4 years were retrospectively reviewed. Etiologies included osteoarthritis (n = 1044), osteonecrosis (n = 35), inflammatory arthritis (n = 34), and post-traumatic arthritis (n = 22). Validated outcome measures, range of motion, and patient satisfaction were recorded. Preoperative and postoperative metrics were compared, and a multivariate analysis was performed to isolate age from sex, body mass index, previous surgery, and diagnosis as independent factors. RESULTS Female patients, patients with a history of surgery, and patients with a diagnosis of osteonecrosis were more likely to undergo TSA when aged 55 years or younger. Both age groups showed similar preoperative range of motion and showed no differences in recorded outcome scores. Postoperatively, patients older than 55 years had slightly greater active abduction (P = .004) and internal rotation (P = .030). A higher percentage of patients older than 55 years rated their outcome as better or much better compared with those aged 55 years or younger (P = .003). CONCLUSIONS Female sex, a history of surgery, and a diagnosis of osteonecrosis were associated with undergoing TSA when aged 55 years or younger. Despite similar preoperative function and minor differences in postoperative range of motion and outcome scores, patients aged 55 years or younger reported lower overall satisfaction with their TSA.
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25
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Gowd AK, Garcia GH, Liu JN, Malaret MR, Cabarcas BC, Romeo AA. Comparative analysis of work-related outcomes in hemiarthroplasty with concentric glenoid reaming and total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:244-251. [PMID: 30269934 DOI: 10.1016/j.jse.2018.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic total shoulder arthroplasty (aTSA) has demonstrated high levels of return to work, although there are fears of glenoid component loosening with higher work demand. METHODS A retrospective query was performed of all patients who received hemiarthroplasty with ream-and-run resurfacing (Hemi RR) between 2005 and 2014. Included patients were matched to an aTSA cohort by age, body mass index, sex, and hand dominance. Preoperative and postoperative work status, by level of duty and occupation, was collected. RESULTS Twenty-five patients receiving Hemi RR and 28 patients receiving TSA completed this questionnaire (82.8% compliance). Mean follow-up was 69.1 ± 24.8 months. In total, 100% of Hemi RR patients returned to work, and 89.3% of TSA patients returned to work (P = .091). The Hemi RR patients had higher rates of return to work for heavy-duty workers only (7 of 7 vs. 2 of 4, P = .038), although only 1 patient in the TSA group reported failure to work was due to shoulder reasons. Mean duration of return to work was 2.5 ± 4.8 months for patients receiving Hemi RR and 1.98 ± 2.6 months for those receiving TSA (P = .653). CONCLUSIONS Hemi RR had a high return to heavy-duty work, likely due to fewer surgeon-imposed restrictions. The results of this study may help manage return to work expectations after Hemi RR according to the level of duty and suggest Hemi RR is a viable option for heavy-duty laborers with end-stage glenohumeral arthritis.
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Affiliation(s)
- Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant H Garcia
- Division of Sports Medicine, Department of Orthopedic Surgery, Seattle Orthopedic Center, Seattle, WA, USA
| | - Joseph N Liu
- Division of Sports Medicine, Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Marissa R Malaret
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brandon C Cabarcas
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, The Rothman Institute, New York, NY, USA.
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26
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Baumgarten KM, Chang PS, Dannenbring TM, Foley EK. Does total shoulder arthroplasty improve patients' activity levels? J Shoulder Elbow Surg 2018; 27:1987-1995. [PMID: 29804913 DOI: 10.1016/j.jse.2018.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) decreases pain, improves range of motion, and increases strength. Whether these improvements translate to improvements in activity levels postoperatively remains unknown. The Shoulder Activity Level (SAL) is a valid and reliable outcomes survey that measures the patient's activity level. Currently, no studies have specifically examined the effect of TSA on SAL. METHODS A prospective collection of preoperative, patient-determined outcomes on patients undergoing TSA was compared with postoperative scores at a minimum of 2 years. These scores included the SAL, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment, Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST). Inclusion criteria were patients undergoing primary anatomic TSA or reverse TSA. RESULTS A mean follow-up of 3.7 years was available for 80 anatomic and 42 reverse TSAs. Anatomic TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (34 to 89; P < .0001), ASES (30 to 87; P < .0001), SST (2 to 9; P < .0001), and SANE scores (23 to 90; P < .0001). The SAL improved from 7 to 8 but did not quite reach statistical significance (P = .07). Reverse TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (31 to 83; P < .0001), ASES (29 to 82; P < .0001), SST (2 to 7; P < .0001), and SANE scores (20 to 85; P < .0001). The SAL improved from 4.5 to 6, but this did not reach statistical significance (P = .38). However, when anatomic and reverse TSAs were analyzed together, a statistically significant improvement was found postoperatively in the SAL (from 6 to 8; P = .006). CONCLUSIONS Anatomic TSA and reverse TSA improved activity levels. In addition, disease-specific and joint-specific quality of life scores all had statistically significant improvements. This study suggests that after shoulder arthroplasty patients in general have (1) significant improvements in their quality of life and (2) have small improvements in activity level. This study shows that most patients do not have to decrease their activity levels to diminish symptoms to an acceptable range.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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27
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Rehabilitation Strategies After Shoulder Arthroplasty in Young and Active Patients. Clin Sports Med 2018; 37:569-583. [DOI: 10.1016/j.csm.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Johnson DJ, Johnson CC, Gulotta LV. Return to Play After Shoulder Replacement Surgery: What Is Realistic and What Does the Evidence Tell Us. Clin Sports Med 2018; 37:585-592. [PMID: 30201172 DOI: 10.1016/j.csm.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article analyzes the available literature regarding return to sport following total shoulder arthroplasty (TSA), hemiarthroplasty (HA), and reverse shoulder arthroplasty (RTSA). It examines the quality of the available evidence and areas of future research. Most patients are able to return to preoperative sport activities following TSA, RTSA, and HA. The rates of return for TSA are slightly higher than those reported for HA and RTSA. Patients may be counseled that noncontact, low-demand activities have higher return rates. Most patients can expect to return to sports within 6 months postoperatively.
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Affiliation(s)
- Daniel J Johnson
- Department of Orthopedic Surgery, McGaw Medical Center of Northwestern University, 676 North Saint Clair Suite 1350, Chicago, IL 60611, USA.
| | - Christine C Johnson
- Department of Orthopedic Surgery, Hospital for Special Surgery, 525 East 70th Street, New York, NY 10021, USA
| | - Lawrence V Gulotta
- Department of Orthopedic Surgery, Hospital for Special Surgery, 525 East 70th Street, New York, NY 10021, USA
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30
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Cabarcas BC, Gowd AK, Liu JN, Cvetanovich GL, Erickson BJ, Romeo AA, Verma NN. Establishing maximum medical improvement following reverse total shoulder arthroplasty for rotator cuff deficiency. J Shoulder Elbow Surg 2018; 27:1721-1731. [PMID: 30030030 DOI: 10.1016/j.jse.2018.05.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since US Food and Drug Administration approval of the reverse prosthesis in 2003, the incidence of shoulder arthroplasty in the United States has risen dramatically. With increasing demand, efforts have shifted from traditional volume-based health care models to more patient-centered care. The purpose of this systematic literature review is to establish the time point of maximum medical improvement (MMI) following reverse total shoulder arthroplasty (rTSA). MATERIALS AND METHODS We conducted a systematic review of studies reporting validated patient-reported outcome measures (PROMs) across multiple postoperative time points following rTSA. Established minimal clinically important difference values for PROMs specific to shoulder arthroplasty were used to determine significant clinical improvement. The time point beyond which significant improvement did not occur was established as MMI. RESULTS MMI occurred at 1 postoperative year following rTSA. When preoperative measures were compared with 1-year postoperative outcomes, all but 1 PROM demonstrated significant clinical improvement (P < .001). There were no significant improvements between any 2 subsequent time points beyond 1 year (P > .050). Range of motion significantly improved between preoperative and 1-year levels (P < .001). No PROMs or range-of-motion parameters significantly improved beyond 1 year (P > .999). CONCLUSIONS Patients achieved MMI at 1 postoperative year following rTSA. Patients showed rapid improvements in subjective symptoms within the first 3 months and continued to gradually improve until 1 year. Surgeons should counsel patients with these evidence-based expectations for clinical recovery, particularly the time frame of expected improvements in pain, function, and range of motion, as well as risks of and plans of action for postoperative complications.
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Affiliation(s)
- Brandon C Cabarcas
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Mannava S, Horan MP, Frangiamore SJ, Hussain ZB, Fritz EM, Godin JA, Pogorzelski J, Millett PJ. Return to Recreational Sporting Activities Following Total Shoulder Arthroplasty. Orthop J Sports Med 2018; 6:2325967118782672. [PMID: 30046628 PMCID: PMC6055269 DOI: 10.1177/2325967118782672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Patients are staying active longer and expect to return to sports or continue participating in recreational activities after total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis. Purpose/Hypothesis: The purpose of this study was to assess the ability of patients to return to recreational sports following TSA. We hypothesized that TSA would allow a high rate of return to recreational sports. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent primary TSA by a single surgeon and were at least 2 years out from surgery were included and were studied for their ability to return to recreational activity following surgery between December 2005 and January 2015. Patient-reported outcomes were obtained, including the 12-Item Short Form Health Survey–Physical Component Summary (SF-12 PCS); Single Assessment Numeric Evaluation (SANE); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; American Shoulder and Elbow Surgeons (ASES) score; and satisfaction scores (10-point scale), preoperatively and at a minimum of 2 years postoperatively. Return-to-sport rates were assessed using a standardized patient-reported outcome questionnaire. Results: A total of 165 patients (186 shoulders) that received TSA met the inclusion criteria for the study. Preoperatively, 139 patients (157 shoulders) were involved in recreational sports; 16 (8.6%) shoulders required additional surgical intervention after the index TSA procedure. A significant postoperative increase was noted in the mean ASES (from 48.3 to 87.0; P < .001), QuickDASH (from 41.0 to 15.8; P < .001), SANE (from 49.1 to 81.2; P < .001), and SF-12 PCS scores (from 38.6 to 48.9; P = .004). Of the 157 shoulders in the recreational sports cohort, responses to the survey examining recreational sporting activities after surgery were available for 112 shoulders. The overall rate of return to sport or recreational activity following TSA was 93.7% (105/112 shoulders). The rate of return to recreational sporting activity equal to or better than the preinjury level was 69.7% (78/112 shoulders), while 6.3% (7/112 shoulders) of our cohort reported that they were unable to compete in recreational sports following TSA. Of the patients who participated in predominantly upper extremity sporting activities after TSA, 49% had to modify their postoperative recreational sporting activity because of lifestyle change, pain, weakness, or decreased range of motion. Conclusion: Patients undergoing TSA showed excellent postoperative improvement in their outcome scores, satisfaction, and return to athletic activities. Despite the expected decrease in activity levels with the slow progression of osteoarthritis over time until TSA was performed, almost 94% of patients successfully returned to various recreational sporting activities postoperatively. This study showed that return to recreational sports can be achieved at participation levels that are comparable with preoperative levels, but athletes in some sports such as tennis or swimming, which require more intense levels of exercise, are less likely to return to the same participation levels.
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Affiliation(s)
- Sandeep Mannava
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Salvatore J Frangiamore
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Erik M Fritz
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jonathan A Godin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Return to Sports After Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis. Arthroscopy 2018; 34:1022-1029. [PMID: 29229415 DOI: 10.1016/j.arthro.2017.09.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the rate of return to sports and clinical outcomes after anteromedialization (AMZ) tibial tubercle osteotomy (TTO) for patients with patellofemoral pain and/or osteoarthritis. METHODS This study is a retrospective case series of consecutive patients who underwent unilateral or staged bilateral AMZ TTO for a primary diagnosis of patellofemoral pain or arthritis. Included were all patients with minimum 1-year follow-up. The indication for surgery was failure of at least 6 months of nonoperative treatment. Simultaneous tubercle distalization or proximal-medial soft-tissue procedures were excluded; however, prior patellar instability procedures did not prohibit inclusion if there was no recurrence. A diagnostic arthroscopy was performed to evaluate the cartilage surfaces; AMZ TTO was performed by use of a freehand technique and two 4.5-mm fully threaded screws for fixation. A gradual return to activities was permitted at 6 months; however, contact sports were prohibited until 9 months postoperatively. Patients were evaluated retrospectively for participation in sports using a questionnaire about the level of participation, return to sporting activities, and Kujala score. Statistical analysis included 1-way analysis of variance and χ2 or Fisher exact and paired t tests. RESULTS Forty-eight patients played sports within 3 years before surgery. The majority were female patients (84.2%). The average age at surgery was 29.6 years, with an average follow-up period of 4.6 years. The average Kujala score improved from 51.2 to 82.6 (P < .0001); the average pain score improved from 4.1 to 1.8 (P < .001). Of the patients, 83.3% returned to at least 1 sport on average 7.8 months postoperatively. Of these, 77.5% believed they returned to sports at the same level or a higher level. CONCLUSIONS Patients undergoing AMZ TTO for patellofemoral pain or arthritis had an 83.3% rate of return to 1 or more sporting activities at an average of 7.8 months after surgery, with many patients returning at the same level or a higher level of intensity compared with their preoperative state. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, Ohue M, Neo M. Return to Sports and Physical Work After Arthroscopic Superior Capsule Reconstruction Among Patients With Irreparable Rotator Cuff Tears. Am J Sports Med 2018; 46:1077-1083. [PMID: 29498887 DOI: 10.1177/0363546517753387] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although sports participation and heavy physical work can contribute to rotator cuff tears, many patients expect to return to these activities after surgery; however, irreparable rotator cuff tears can preclude this outcome. A new surgical treatment-arthroscopic superior capsule reconstruction (SCR)-restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function and relieves pain. PURPOSE To evaluate the rates of return to sports and physical work among patients treated with arthroscopic SCR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From 2007 to 2014, we performed arthroscopic SCR in 105 patients with irreparable rotator cuff tears, 5 of whom were lost to follow-up. Consequently, 100 patients (mean age, 66.9 years; range, 43-82 years) were enrolled in the study. Before surgery, 26 patients had participated in sports (2 competitive, 24 recreational), and 34 patients had physical work. Rates of return to sports and physical work, the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, and rate of graft tear were evaluated. The mean time to final follow-up was 48 months (range, 24-88 months). RESULTS All 26 patients who played sports before their injuries returned fully to them. In addition, 32 patients returned fully to their previous physical work, whereas the 2 remaining patients returned with reduced hours and workloads. As compared with the nonsports group, the sports group had significantly higher postoperative active elevation (160° ± 32° vs 146° ± 39°; P = .04) and higher postoperative ASES scores (97 ± 7 vs 91 ± 12; P = .02). The shoulder range of motion and ASES scores before and after surgery did not differ significantly between the physical and nonphysical work groups ( P = .11-.99). The rate of graft tear did not differ between the sports group (4%) and nonsports group (5%) ( P = .75) and between the physical work group (6%) and nonphysical work group (5%) ( P = .77). CONCLUSION Arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sports and physical work.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.,Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, USA.,Department of Orthopaedic Surgery, University of California, Irvine, California, USA.,Katsuragi Hospital, Kishiwada, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, USA.,Department of Orthopaedic Surgery, University of California, Irvine, California, USA
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yukitaka Fujisawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takeshi Kawakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Return to sport after shoulder arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:100-112. [PMID: 28409200 DOI: 10.1007/s00167-017-4547-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/10/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE With increasing incidence and indications for shoulder arthroplasty, there is an increasing emphasis on the ability to return to sports. The main goal of this study was to determine the rate of return to sport after shoulder arthroplasty. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and meta-analysis. A search was performed on MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the Methodological Index for Nonrandomized Studies checklist. The main judgement outcome was the rate of return to sports activity after shoulder arthroplasty and the level of play upon return (identical or higher/lower level). RESULTS Thirteen studies were reviewed, including 944 patients (506 athletes), treated with shoulder arthroplasty at an average follow-up of 5.1 years (range, 0.5-12.6 years). The most common sports were swimming (n = 169), golf (n = 144), fitness sports (n = 71), and tennis (n = 63). The overall rate of return to sport was 85.1% (95% CI, 76.5-92.3%), including 72.3% (95% CI, 60.6-82.8%) returning to an equivalent or improved level of play, after 1-36 months. Patients undergoing anatomic total shoulder arthroplasty returned at a significantly higher rate (92.6%) compared to hemiarthroplasty (71.1%, p = 0.02) or reverse total shoulder arthroplasty (74.9%, p = 0.003). CONCLUSION Most patients are able to return to one or more sports following shoulder arthroplasty, with anatomic total shoulder arthroplasty having the highest rate of return. LEVEL OF EVIDENCE IV.
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Return to sports after reverse shoulder arthroplasty-the Swiss perspective. INTERNATIONAL ORTHOPAEDICS 2017; 42:1129-1135. [PMID: 29273836 DOI: 10.1007/s00264-017-3715-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/03/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE This patient survey evaluated the return to previous sports activities in Swiss patients up to five years after reverse shoulder arthroplasty (RSA). METHODS We screened our local shoulder arthroplasty registry for patients registered with a unilateral RSA due to rotator cuff deficiency between May 2010 and May 2015. Revision cases and patients already known as unwilling or unable to complete a German language questionnaire were excluded. Eligible patients received a paper questionnaire asking about their past and current sports activities, return time point and level of activity. RESULTS Of 305 patients, 89% responded at a mean post-operative follow-up of 2.9 years (SD 1.1). The respondents had a mean age of 77.1 years (SD 7.8) and included 62% females. The overall rate of patients returning to a previous sports activity was 77%. Sixty-one percent (166/271) participated in regular sports activities before the onset of their shoulder disorders. After RSA, 47% (127/271) participated in at least one sport type with the most frequent activities including hiking (66), swimming (53), cycling (45) and callisthenics (43). Most patients carried out their main sports activity after surgery with a moderate level of intensity (83%) and between one to three times per week (69%). Forty-two percent of the respondents indicated that returning to sports was among their key demands after RSA. CONCLUSIONS Returning to previous sports activities is an important expectation of RSA patients, and the majority do. Patient expectations of post-operative sports activity need to be addressed when planning RSA.
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Pearl ML. CORR Insights ®: Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty? Clin Orthop Relat Res 2017; 475:2740-2743. [PMID: 28866848 PMCID: PMC5638740 DOI: 10.1007/s11999-017-5457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Michael Lawrence Pearl
- Department of Orthopedic Surgery, Kaiser Permanente, 4760 Sunset Blvd, Los Angeles, CA 90027-6021 USA
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Hurwit DJ, Liu JN, Garcia GH, Mahony G, Wu HH, Dines DM, Warren RF, Gulotta LV. A comparative analysis of work-related outcomes after humeral hemiarthroplasty and reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:954-959. [PMID: 28089256 DOI: 10.1016/j.jse.2016.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The return to work of young patients undergoing shoulder arthroplasty is increasingly important. Whereas studies have shown superior outcomes of reverse total shoulder arthroplasty (RTSA) compared with humeral hemiarthroplasty (HHA), no prior literature has compared RTSA with HHA in regard to return to work. METHODS A retrospective review of a prospectively collected shoulder arthroplasty registry was performed to analyze all patients who underwent RTSA or HHA at a single institution. A validated questionnaire evaluating return to work postoperatively was administered at baseline and at follow-up in addition to the American Shoulder and Elbow Surgeons and visual analog scale (VAS) pain surveys. RESULTS The study included 40 RTSA and 41 HHA patients. The average age at surgery was 68.6 years in the RTSA group and 60.8 years in the HHA group (P < .001). Postoperatively, 65% of RTSA patients returned to work compared with 70.7% of HHA patients (P = .64). There was no significant difference in the time to return to work between the RTSA (2.3 months) and HHA (3.1 months) groups (P = .46). Both groups had statistically significant improvements in both the American Shoulder and Elbow Surgeons and VAS scores. The improvement in pain on the VAS for patients undergoing RTSA (-5.6) trended toward significance compared with HHA (-4.2) (P = .056). CONCLUSION Roughly two-thirds of patients undergoing either HHA or RTSA were able to return to work postoperatively, with no significant difference found between the 2 groups in terms of time to return to work, despite that patients undergoing RTSA were significantly older.
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Affiliation(s)
| | | | | | - Gregory Mahony
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Hao-Hua Wu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Johnson CC, Johnson DJ, Liu JN, Dines JS, Dines DM, Gulotta LV, Garcia GH. Return to sports after shoulder arthroplasty. World J Orthop 2016; 7:519-526. [PMID: 27672564 PMCID: PMC5027006 DOI: 10.5312/wjo.v7.i9.519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/30/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication.
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