Study reports on return to work, play after shoulder hemiarthroplasty

Patients who returned to high-demand sports were younger than those returning to low-demand sports.

Results from this study indicated among patients who underwent shoulder hemiarthroplasty, 67.2% participated in at least one sport at a postoperative average of 6.5 months and 69.4% of patients returned to work at average of 1.4 months postoperatively.

“We can now counsel active patients who are preoperative candidates for shoulder hemiarthroplasty and give them predictive numbers for return to their desired sport,” Grant H. Garcia, MD, resident at the Department of Orthopedic Surgery at Hospital for Special Surgery in New York City, told Orthopedics Today. “Furthermore, we have a better understanding that while patients after hemiarthroplasty have a high rate of return, this is not as high as patients who undergo total shoulder replacement.”

Retrospective study

Grant H. Garcia, MD
Grant H. Garcia

Garcia and his colleagues retrospectively reviewed 79 patients who underwent shoulder hemiarthroplasty. Patients were completed a questionnaire regarding physical fitness, sports and work status. VAS pain scores and American Shoulder and Elbow Surgeon (ASES) scores were also recorded preoperatively.

Sports were categorized according to high or low upper extremity usage. Rates of return for each sport also were calculated.

Return rates

Results showed both VAS pain scores and ASES scores improved from preoperative to postoperative values (6.2 to 2.1 and 34.6 to 71.3, respectively). Investigators noted patients older than 65 years had a significantly lower average postoperative ASES score than patients younger than 65 years of age. Revision shoulder arthroplasty was required in four patients.

Overall, 39 of the 58 patients who participated in sports preoperatively returned to at least one sport in which they previously participated. Patients who returned to high-demand sports were significantly younger compared with patients who returned to low-demand sports.

That said, “higher demand and sports that require more upper extremity use have lower rates of return overall,” Garcia said.

Return rates were 69% for fitness sports, 67% for softball, 65% for swimming, 64% for running, 63% for cycling and 57% for doubles tennis. After 2 years of follow-up, the complication rate was 10.1%. Of the 49 patients who worked preoperatively, 69.4% returned to their previous employment. On average, patients with a higher BMI did not return to work.

Garcia and his colleagues recorded rates of return for patients who were active prior to shoulder surgery, so the data reported may not be useful for patients who start a new sport. He also noted radiographs of this active population were not evaluated, leaving him unable to determine whether either subclinical radiologic loosening or implant damage occurred. Radiographs would, however, be assessed in a potential long-term study.

“Our next steps would be to follow these patients for another 5 years and evaluate long-term success of hemiarthroplasty in maintaining an active lifestyle,” Garcia said. Investigators would determine if an increase in activity would impact component loosening long-term.

According to Garcia, this study would help manage active patients who would qualify for hemiarthroplasty. by Monica Jaramillo

Disclosure: Garcia reports no relevant financial disclosures.

Results from this study indicated among patients who underwent shoulder hemiarthroplasty, 67.2% participated in at least one sport at a postoperative average of 6.5 months and 69.4% of patients returned to work at average of 1.4 months postoperatively.

“We can now counsel active patients who are preoperative candidates for shoulder hemiarthroplasty and give them predictive numbers for return to their desired sport,” Grant H. Garcia, MD, resident at the Department of Orthopedic Surgery at Hospital for Special Surgery in New York City, told Orthopedics Today. “Furthermore, we have a better understanding that while patients after hemiarthroplasty have a high rate of return, this is not as high as patients who undergo total shoulder replacement.”

Retrospective study

Grant H. Garcia, MD
Grant H. Garcia

Garcia and his colleagues retrospectively reviewed 79 patients who underwent shoulder hemiarthroplasty. Patients were completed a questionnaire regarding physical fitness, sports and work status. VAS pain scores and American Shoulder and Elbow Surgeon (ASES) scores were also recorded preoperatively.

Sports were categorized according to high or low upper extremity usage. Rates of return for each sport also were calculated.

Return rates

Results showed both VAS pain scores and ASES scores improved from preoperative to postoperative values (6.2 to 2.1 and 34.6 to 71.3, respectively). Investigators noted patients older than 65 years had a significantly lower average postoperative ASES score than patients younger than 65 years of age. Revision shoulder arthroplasty was required in four patients.

Overall, 39 of the 58 patients who participated in sports preoperatively returned to at least one sport in which they previously participated. Patients who returned to high-demand sports were significantly younger compared with patients who returned to low-demand sports.

That said, “higher demand and sports that require more upper extremity use have lower rates of return overall,” Garcia said.

Return rates were 69% for fitness sports, 67% for softball, 65% for swimming, 64% for running, 63% for cycling and 57% for doubles tennis. After 2 years of follow-up, the complication rate was 10.1%. Of the 49 patients who worked preoperatively, 69.4% returned to their previous employment. On average, patients with a higher BMI did not return to work.

Garcia and his colleagues recorded rates of return for patients who were active prior to shoulder surgery, so the data reported may not be useful for patients who start a new sport. He also noted radiographs of this active population were not evaluated, leaving him unable to determine whether either subclinical radiologic loosening or implant damage occurred. Radiographs would, however, be assessed in a potential long-term study.

“Our next steps would be to follow these patients for another 5 years and evaluate long-term success of hemiarthroplasty in maintaining an active lifestyle,” Garcia said. Investigators would determine if an increase in activity would impact component loosening long-term.

According to Garcia, this study would help manage active patients who would qualify for hemiarthroplasty. by Monica Jaramillo

Disclosure: Garcia reports no relevant financial disclosures.