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Return to sport after shoulder arthroplasty: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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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References

  1. Borm GF, Lemmers O, Fransen J, Donders R (2009) The evidence provided by a single trial is less reliable than its statistical analysis suggests. J Clin Epidemiol 62(711–715):e1

    Google Scholar 

  2. Bulhoff M, Sattler P, Bruckner T, Loew M, Zeifang F, Raiss P (2015) Do patients return to sports and work after total shoulder replacement surgery? Am J Sports Med 43:423–427

    Article  PubMed  Google Scholar 

  3. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  4. Egger M, Schneider M, Davey Smith G (1998) Spurious precision? Meta-analysis of observational studies. BMJ 316:140–144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Eichinger JK, Miller LR, Hartshorn T, Li X, Warner JJ, Higgins LD (2015) Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival. J Shoulder Elbow Surg 25:772–780

    Article  PubMed  Google Scholar 

  7. Flurin PH, Roche CP, Wright TW, Marczuk Y, Zuckerman JD (2013) A comparison and correlation of clinical outcome metrics in anatomic and reverse total shoulder arthroplasty. Bull Hosp Jt Dis 73:118–123

    Google Scholar 

  8. Freeman M, Tukey J (1950) Transformations related to the angular and the square root. Ann Math Stat 21:607–611

    Article  Google Scholar 

  9. Garcia GH, Liu JN, Mahony GT, Sinatro A, Wu HH, Craig EV, Warren RF, Dines DM, Gulotta LV (2016) Hemiarthroplasty versus total shoulder arthroplasty for shoulder osteoarthritis: a matched comparison of return to sports. Am J Sports Med 44:1417–1422

    Article  Google Scholar 

  10. Garcia GH, Mahony GT, Fabricant PD, Wu HH, Dines DM, Warren RF, Craig EV, Gulotta LV (2016) Sports- and work-related outcomes after shoulder hemiarthroplasty. Am J Sports Med 44:490–496

    Article  PubMed  Google Scholar 

  11. Garcia GH, Taylor SA, DePalma BJ, Mahony GT, Grawe BM, Nguyen J, Dines JS, Dines DM, Warren RF, Craig EV, Gulotta LV (2015) Patient activity levels after reverse total shoulder arthroplasty: what are patients doing? Am J Sports Med 43:2816–2821

    Article  PubMed  Google Scholar 

  12. Golant A, Christoforou D, Zuckerman JD, Kwon YW (2012) Return to sports after shoulder arthroplasty: a survey of surgeons’ preferences. J Shoulder Elbow Surg 21:554–560

    Article  PubMed  Google Scholar 

  13. Henn RF, Ghomrawi H, Rutledge JR, Mazumdar M, Mancuso CA, Marx RG (2011) Preoperative patient expectations of total shoulder arthroplasty. J Bone Joint Surg Am 93:2110–2115

    Article  PubMed  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jain NB, Yamaguchi K (2014) The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg 23:1905–1912

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jensen KL, Rockwood CA Jr (1998) Shoulder arthroplasty in recreational golfers. J Shoulder Elbow Surg 7:362–367

    Article  CAS  PubMed  Google Scholar 

  17. Khatib O, Onyekwelu I, Yu S, Zuckerman JD (2015) Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization. J Shoulder Elbow Surg 24:e286–e291

    Article  PubMed  Google Scholar 

  18. Kim SH, Wise BL, Zhang Y, Szabo RM (2011) Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 93:2249–2254

    Article  PubMed  Google Scholar 

  19. Labriola JE, Edwards TB (2008) Reverse total shoulder arthroplasty in the senior athlete. Oper Techn Sports Med 16:43–49

    Article  Google Scholar 

  20. Lefevre N, Rousseau D, Bohu Y, Klouche S, Herman S (2013) Return to judo after joint replacement. Knee Surg Sports Traumatol Arthrosc 21:2889–2894

    Article  PubMed  Google Scholar 

  21. Liu JN, Garcia GH, Mahony G, Wu HH, Dines DM, Warren RF, Gulotta LV (2016) Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total shoulder replacement. J Shoulder Elbow Surg 25:920–926

    Article  PubMed  Google Scholar 

  22. McCarty EC, Marx RG, Maerz D, Altchek D, Warren RF (2008) Sports participation after shoulder replacement surgery. Am J Sports Med 36:1577–1581

    Article  PubMed  Google Scholar 

  23. Miller JJ (1978) The inverse of the Freeman-Tuckey double arcsine transformation. Am Stat 32:138

    Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J, Altma DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341

    Article  PubMed  Google Scholar 

  25. Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S, Munzinger U, Drobny T (2007) Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 35:1688–1695

    Article  PubMed  Google Scholar 

  26. Papaliodis D, Richardson N, Tartaglione J, Roberts T, Whipple R, Zanaros G (2015) Impact of total shoulder arthroplasty on golfing activity. Clin J Sport Med 25:338–340

    Article  PubMed  Google Scholar 

  27. Schairer WW, Nwachukwu BU, Lyman S, Craig EV, Gulotta LV (2015) National utilization of reverse total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 24:91–97

    Article  PubMed  Google Scholar 

  28. Schumann K, Flury MP, Schwyzer HK, Simmen BR, Drerup S, Goldhahn J (2010) Sports activity after anatomical total shoulder arthroplasty. Am J Sports Med 38:2097–2105

    Article  PubMed  Google Scholar 

  29. Shrier I, Platt RW, Steele RJ (2007) Mega-trials vs. meta-analysis: precision vs. heterogeneity? Contemp Clin Trials 28:324–328

    Article  PubMed  Google Scholar 

  30. Simovitch R, Flurin PH, Marczuk Y, Friedman R, Wrigh TW, Zuckerman JD (2013) Roche CP (2015) Rate of Improvement in Clinical Outcomes with Anatomic and Reverse Total Shoulder Arthroplasty. Bull Hosp Jt Dis 73:111–117

    Google Scholar 

  31. Simovitch RW, Gerard BK, Brees JA, Fullick R, Kearse JC (2015) Outcomes of reverse total shoulder arthroplasty in a senior athletic population. J Shoulder Elbow Surg 24:1481–1485

    Article  PubMed  Google Scholar 

  32. Skutek M, Fremerey RW, Bosch U (1998) Level of physical activity in elderly patients after hemiarthroplasty for three- and four-part fractures of the proximal humerus. Arch Orthop Trauma Surg 117:252–255

    Article  CAS  PubMed  Google Scholar 

  33. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  PubMed  Google Scholar 

  34. Turner RM, Spiegelhalter DJ, Smith GC, Thompson SG (2009) Bias modelling in evidence synthesis. J R Stat Soc Ser A Stat Soc 172:21–47

    Article  PubMed  PubMed Central  Google Scholar 

  35. Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM (2015) Reverse shoulder arthroplasty in the United States: a comparison of national volume, patient demographics, complications, and surgical indications. Iowa Orthop J 35:1–7

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Wylde V, Blom A, Dieppe P, Hewlett S, Learmonth I (2008) Return to sport after joint replacement. J Bone Joint Surg Br 90:920–923

    Article  CAS  PubMed  Google Scholar 

  37. Zarkadas PC, Throckmorton TQ, Dahm DL, Sperling J, Schleck CD, Cofield R (2011) Patient reported activities after shoulder replacement: total and hemiarthroplasty. J Shoulder Elbow Surg 20:273–280

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA

    Joseph N. Liu, Michael E. Steinhaus & Grant H. Garcia

  2. Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA

    Brenda Chang & Kara Fields

  3. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA

    David M. Dines, Russell F. Warren & Lawrence V. Gulotta

Authors
  1. Joseph N. Liu
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  2. Michael E. Steinhaus
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  3. Grant H. Garcia
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  4. Brenda Chang
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  5. Kara Fields
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  6. David M. Dines
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  7. Russell F. Warren
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  8. Lawrence V. Gulotta
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Corresponding author

Correspondence to Joseph N. Liu.

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Conflict of interest

Dr. Dines and Dr. Warren receive royalties from Biomet, which is related to the subject of this work. Dr. Gulotta receives consultant payments from Biomet, which is related to the subject of this work. None of the other authors has any financial conflict of interest pertaining to this manuscript.

Funding

There was no outside funding or grants received that assisted in this study.

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Ethical approval was obtained from institutional review board.

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Liu, J.N., Steinhaus, M.E., Garcia, G.H. et al. Return to sport after shoulder arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 26, 100–112 (2018). https://doi.org/10.1007/s00167-017-4547-1

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  • DOI: https://doi.org/10.1007/s00167-017-4547-1

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