Abstract
Patient perceptions regarding the functional outcomes and return to sports after shoulder replacement are often pessimistic, with many patients presenting for shoulder replacement surgery after months or years of avoiding the procedure so they could continue to live the current life they have, despite the increasing pain and dysfunction. Less common, but becoming more frequent, patients present with expectations that they will be able to return to all activities including heavy resistance training, cross-fit, rock climbing, and other strenuous overhead sports. In the past, little information has been available regarding the activities of shoulder arthroplasty patients after surgery. Typically, the boundaries have been set by the surgeon, with many patients cautioned or even prohibited from overhead sports, weight training, or heavy work responsibilities. A typical set of guidelines may include no repetitive overhead sports, except for recreational swimming, and no lifting over 20 pounds. Golf, jogging, hiking and other activities are allowed.
The origin of these restricted guidelines and expectations is unknown, but many believe that since the results of shoulder replacements are less favorable in younger patients, it may be due to the overuse or abuse of the shoulder joint that is more typical at a younger age. Others have suggested that common sense prevails and that an artificial joint made of metal and plastic has a finite number of total movements and tolerance to resistance activities, and therefore keeping these activities at a minimum would extend the longevity of the artificial joint. None of these concepts are backed up by evidence-based literature, essentially reflecting the personal bias of the surgeons who care for patients with these problems. Despite all of the sophisticated research, scoring scales, outcome measures, and value-based metrics, the only outcome that really matters is whether the patient can return back to their normal way of life, at home, at work, during sport, or any activity that is important to them.
Recent studies of patients who have had joint replacement surgery have revealed that our patients who participated in sports and work activities before surgery have a strong predilection to returning to those activities after successful shoulder replacement. The most common sports that shoulder arthroplasty patients enjoy including golf, swimming, tennis, but may also include many other choices including fitness activities, rowing, skiing, basketball, and softball. As expected, the return to these sports is less for reverse shoulder arthroplasty patients vs. anatomic shoulder arthroplasty patients. In a systematic review, more than 90% of anatomic shoulder replacement patients returned to sport, while 75% of reverse shoulder arthroplasty patients returned to some sporting activity. This may reflect the constraints of the reverse prosthesis, or, quite possibly reflect the typically older age and more sedentary lifestyle of patients who are indicated for reverse shoulder arthroplasty. In addition, if the patient had a preoperative expectation of return to recreational and sports activities as part of their normal way of life, their final results demonstrated better overall outcomes.
Shoulder arthroplasty surgeons should be concerned about the outcomes desired by our patients, and the results that provide true value to their lives. We are now more aware of the activities that they are going to return to, whether we recommend restrictions or not.
