Effect of primary diagnosis on return to sport after reverse total shoulder arthroplasty

Abstract

BackgroundIncreasing evidence exists regarding the impact of primary diagnosis on clinical outcomes following reverse total shoulder arthroplasty (RTSA). Expanding indications coupled with emerging clinical evidence has resulted in increased use of RTSA for glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. The ability to return to sports after RTSA is a common concern for patients; however, most literature evaluating this does not stratify patients by diagnosis. The purpose of this investigation was to evaluate the effect of diagnosis on return to sports after RTSA. MethodsA single institution, retrospective study was performed on patients who underwent primary RTSA with a minimum 2-year follow-up. Patients answered a 7-question survey regarding sport participation within 3 years before surgery and the level to which they returned to their sports after surgery. Patient demographics, patient-reported outcome scores, and range of motion were accessed from the database. Descriptive statistics and univariate analysis were performed to assess differences between patients who did not return to sport or did so at lower level and those that returned at the same or higher level, as well as between patients with GHOA and those with rotator cuff disease. Binary logistic regression was performed to assess predictors of returning to sports. ResultsA total of 106 patients meeting inclusion criteria were identified with a mean age of 72 years (range, 55-88 years). Ninety-six patients (90.6%) returned to playing sports, of which 84 (87.5%) returned at the same or higher level. Patients with GHOA demonstrated a higher rate of return to sport compared to those with rotator cuff disease (95.6% vs. 81.6%; P = .033). Logistic regression controlling for sport intensity demonstrated that GHOA is a predictor of returning to sports (odds ratio = 6.3; P = .017). Patients who did not return to sports or did so at a lower level had higher preoperative pain (P = .007), lower postoperative SANE (Single Assessment Numerical Evaluation of the Shoulder) (P = .027), lower preoperative and postoperative ASES (American Shoulder and Elbow Surgeons) scores (P = .004 and P = .016, respectively), less preoperative and postoperative forward elevation (P = .037 and P = .019, respectively), lower postoperative external rotation (P = .004), and lower preoperative internal rotation (P = .027). ConclusionThe ability of patients to return to sports after RTSA is highly influenced by preoperative diagnosis. Patients with GHOA have higher rates of return to sport than previously recognized. These results are useful for establishing expectations with patients regarding their postoperative activity level.