The present study was conducted to compare the clinical and radiographic outcomes of reverse total shoulder arthroplasty (RTSA) in a senior athletic and non-athletic population. The hypothesis was that athletic high-demand patients demonstrate a higher rate of radiological changes around the implant such as radiolucency, loosening, and scapular notching when compared to non-athletic patients.
In this retrospective study, 71 consecutive patients who underwent RTSA with the Universe Reverse shoulder prosthesis were included. Minimum follow-up was 24 months. Patients who restarted sport following RTSA were assigned to the athletic group, while patients who discontinued sports were assigned to the non-athletic group. Outcome was evaluated with the Constant score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Simple-Shoulder Test (SST), and a visual analog scale (VAS) for pain. Shoulder range of motion and abduction strength was assessed. Radiographic follow-up examination was based on a standardized core set of parameters for radiographic monitoring of patients following shoulder arthroplasty.
61 patients (f:36; m:25; mean age 75.9 years) were available for follow-up survey (Follow-up: 47.1 months). 34 patients were assigned to the athletic group and 27 patients to the non-athletic group. The overall rate of return to sport was 78 %. The athletic group demonstrated superior clinical results and patient-rated-outcomes (PROs) with CS 68.6 (SD: 10.4), ASES 87.0 (SD: 10.4), SST 9.1 (SD: 2.0) and VAS 0.1 (SD: 0.3) compared to the non-athletic group (CS 55.2 (SD: 17.2), ASES 71.5 (SD: 21.3), SST 6.8 (SD: 2.9) and VAS 2.2 ( SD2.1)), respectively (P<.05). Incomplete radiolucency around the humeral component was found significantly more frequent in the athletic group compared to the non-athletic group (P=.019), whereas the occurrence of complete radiolucent lines around the implant components demonstrated no statistical difference between the two groups (P=.382). Incomplete radiolucency around the glenoid component was observed in 1 patient (3 %) of the athletic group, and 3 patients (11 %) of the non-athletic group (P=.2). There was no loosening and/or migration of the glenoid component. Scapular notching was observed in 18 patients (53 %) of the athletic group and 12 patients (44 %) of the non-athletic group (P=.51).
At mid-term follow-up, the athletic population demonstrated significantly better clinical results following RTSA without a higher rate of radiographic changes when compared to non-athletic patients. However, incomplete radiolucency around the humeral component was observed significantly more often in the athletic group, which may affect long-term implant survivorship.