Summary

Sports active reverse total shoulder arthroplasty patients had less cardiovascular or respiratory disease and better perceived shoulder function than non-sports active patients.

Abstract

Objective

Recreational sports participation may decrease cardiovascular (CV) and respiratory system (RS) disease. This study evaluated the influence of CV or RS disease on the perceived shoulder function and normalcy of sports active (SA) reverse total shoulder arthroplasty (RTSA) patients over the initial 5-years post-RTSA compared to non-sports active (NSA) patients.

Methods

Two hundred patients (108 female) participated in this retrospective study. The SA group had 52 patients (69.2 ± 9 years of age, male = 57.7%, n = 30) who participated in golf (n = 10), cycling (n = 9), fishing-hunting (n = 9), weight training (n = 5), swimming (n = 5), bowling (n = 3), target shooting (n = 2), sailing (n = 2), archery (n = 2), tennis (n = 2), hiking (n = 1), kayaking (n = 1), and flag football (n = 1). The NSA group had 148 patients (68.9 ± 8 years of age, female = 58.1%, n = 86). Patients underwent RTSA for gross rotator cuff deficiency (n = 92), osteoarthritis (n = 88), failed total shoulder arthroplasty (n = 8), non-united humeral head fracture (n = 6) or comminuted humeral head fracture (n = 6) with similar group distributions (p = 0.24). Patients completed the American Shoulder and Elbow Society (ASES) Score, the Single Assessment Numeric Evaluation (SANE) score, and were evaluated for implant failure/revision. Data was collected pre-RTSA, and at 6-week, 6-month, 1-year, 2-year, 3-year, and 5-year follow-ups. Patients were categorized into Group 1 (SA with no CV or RS disease, n = 20); Group 2 (SA with either CV or RS disease, n = 32); Group 3 (NSA with no CV or RS disease, n = 28); or Group 4 (NSA with either CV or RS disease, n = 120) and statistical comparisons were made using two-way ANOVA (group, follow-up period) and Tukey post-hoc tests (p ≤ 0.05).

Results

Groups had similar age and gender distributions (p ≥ 0.24). Overall, the SA group had less CV disease (60%, 31/52 patients vs. 75.7%, 112/148 patients, p = 0.05) and less RS disease (15.4%, 8/52 vs. 30.4%, 45/148, p = 0.03) than the NSA group. Group differences were observed for ASES score (p = 0.03) by follow-up period (p < 0.001) with Group 1 displaying higher ASES scores compared to Group 3 (p = < 0.001) and Group 4 (p = 0.05), but not differing from Group 2 (p = 0.56). Group differences were also observed for SANE score (p = 0.012) by follow-up period (p < 0.001) with Group 2 (p = 0.03) and Group 4 (p = 0.004) displaying higher scores than Group 3 (p = 0.03). Group 1 did not differ from the other groups (p ≥ 0.24). Groups had equivalent implant failure rates. Groups had equivalent implant revision rates. Group 4 (Non-Sports Active with either CV or RS disease) had more activity or fall-related fractures than the other groups
(p = 0.002).

Conclusion

Recreational Sports Active patients had less frequent CV or RS disease and greater shoulder function. Groups had equivalent implant revision rates, however, Group 4 (Non-Sports Active with either CV or RS disease) had more activity or fall-related fractures suggesting possible balance or neuromuscular control impairments.