Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis

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.

Impact of Sports Activity on Medium-Term Clinical and Radiological Outcome after Reverse Shoulder Arthroplasty in Cuff Deficient Arthropathy; An Institutional Register-Based Analysis

“…Only a few systematic reviews or meta-analyses have considered the return to sport after RSA [ 8 , 9 ]. From these reports, 74.9% [ 8 ] and 77% [ 9 ] of patients who performed sports preoperatively returned to sports after RSA. A similar proportion of 77% was reported for the RSA population from which our analysis groups were selected [ 6 ].…”

“…While clinical and radiological outcome parameters are well established and show good results after implantation [ 4 ], there is scant scientific evidence on the outcome of patients participating in sports after RSA. Two systematic reviews and meta-analysis have identified several scientific approaches made to investigate sports related outcomes after shoulder arthroplasty, yet there is a vast heterogeneity of the methodological approaches and the implants used (anatomical total shoulder arthroplasty, hemi shoulder arthroplasty, RSA), and only few medium-term outcomes with 5 years have been reported [ 8 , 9 ]. The frequency and type of sport activities undertaken by RSA patients show that return to sport participation rates are as high as 74.9–85.5% after surgery [ 6 , 7 , 8 , 9 ].…”

“…Two systematic reviews and meta-analysis have identified several scientific approaches made to investigate sports related outcomes after shoulder arthroplasty, yet there is a vast heterogeneity of the methodological approaches and the implants used (anatomical total shoulder arthroplasty, hemi shoulder arthroplasty, RSA), and only few medium-term outcomes with 5 years have been reported [ 8 , 9 ]. The frequency and type of sport activities undertaken by RSA patients show that return to sport participation rates are as high as 74.9–85.5% after surgery [ 6 , 7 , 8 , 9 ]. Yet there is little knowledge about clinical and radiological outcomes, and there is a particular lack of a comparative cohort for those actively participating in sports mainly involving the upper extremities.…”

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 2

“…As life expectancy is increasing, active older patients expect better functional outcomes as well as good pain relief in order to return to their recreational activities after surgery [26]. A recent systematic review evaluated the rate of return to sport in older patients who underwent aTSA and rTSA [27]. The overall rate of return to sport was 82%.…”