Original Research

Return to Sports After Primary Reverse
Shoulder Arthroplasty
Outcomes at Mean 4-Year Follow-up
Jennifer Tangtiphaiboontana,* MD, Kristin C. Mara,* MS, Andrew R. Jensen,* MD, MBE,
Christopher L. Camp,* MD, Mark E. Morrey,* MD, and Joaquin Sanchez-Sotelo,*† MD, PhD
Investigation performed at Mayo Clinic, Rochester, Minnesota, USA
Background: With the expanding use of reverse shoulder arthroplasty (RSA) to treat various shoulder conditions, there has been arise in the number of RSAs performed, especially in physically active patients. Limited information regarding sports after RSA isavailable to properly counsel patients on postoperative expectations.
Purpose: To assess the rate of return to sports as well as the ability to return to the same level of preoperative intensity, frequency,
and duration of sport after primary RSA.
Study Design: Case series; Level of evidence, 4.
Methods: This was a retrospective review of patients who underwent primary RSA at our institution between 2014 and 2016.
Shoulder motion, Subjective Shoulder Value score, American Shoulder and Elbow Surgeons score, pre- and postoperative sports
activities, and barriers to return to sport were assessed in 109 patients after RSA (93 patients with unilateral RSA and 16 patientswith bilateral RSA). The mean age at the time of surgery was 70 years (range, 34-86 years), with a mean follow-up of 3.9 years(range, 2-12 years).
Results: The mean rate of return to sports was 70.1% (range, 0%-100%). There was no difference in return to sports between
those with uni- and bilateral RSA (P ¼ .64). Fishing, swimming, elliptical/treadmill, and hunting were the most common sports after
RSA with return rates of 91%, 73%, 86%, and 82% respectively. A majority of patients returned to the same level of preoperative
intensity, frequency, and duration for all sports except for climbing and swimming. There was a lower mean rate of return for highdemand sports (62.9%) compared with low- and medium-demand sports (76.7%) (P ¼ .005). The most common reasons forinability to return to sports included limited motion, fear of injury, and weakness.
Conclusion: Patients who had undergone primary uni- or bilateral RSA reported a 70.1% rate of return to sports with maintenanceof the same level of intensity, duration, and frequency of preoperative sport participation. Rates of return to high-demand sports
were lower than low- and medium-demand sports. Patients also had difficulty returning to overhead sports.
Keywords: reverse total shoulder arthroplasty; sports; activity

The number of reverse shoulder arthroplasty (RSA) surgeries
performed continues to rise as the surgical indications
expand to include pathologies such as irreparable massive
rotator cuff tears, primary osteoarthritis with severe subluxation or bone loss, acute proximal humeral fractures, andproximal humeral fracture nonunions.13,23-25,30 While pain
relief and restoration of shoulder function for activities ofdaily living (ADLs) are often the main goals of RSA, physically active patients often ask their surgeon about activities
and sports that they will or will not be able to perform after
recovery from surgery. A study by Lawrence et al15 reported

that 53% of the patients who underwent an RSA were still
able to perform high-demand activities, such as snow anddirt shoveling. Assenmacher et al1 also found that after having both shoulders replaced with RSA, 55% of the patientswere able to perform high-demand activities after surgery
and had minimal difficulty with ADLs.
The ability to participate in sports after joint-replacement surgery is a common concern of patients regarding
expectations after RSA, and it is important for patient quality of life. While return to sports after arthroplasty has beenwell-analyzed for anatomic total shoulder arthroplasty(TSA) and hemiarthroplasty (HA),2,6-8,21,22,26 there are limited data evaluating the ability to return to sports after
RSA. The reported return to sports rate after RSA has varied between 40% and 85%.3-5,10,14,19,27,31 As patients remain

The Orthopaedic Journal of Sports Medicine, 9(6), 23259671211012393
DOI: 10.1177/23259671211012393ª The Author(s) 2021

This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source arecredited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.

1

2Tangtiphaiboontana et al

active later in life and the indications for RSA continue torise, it is critical that we improve our understanding ofrecreation and sporting activity after RSA.
Accordingly, the primary purposes of this study were toassess the rate of return to sports after primary RSA andevaluate the ability to return to the same level of intensity,
frequency, and duration of sport compared with before surgery. We hypothesized that patients would be able to consistently return to low- to moderate-demand sporting andfitness activities with fewer returning to high-demand
sporting activities.

METHODS
Study Cohort
After institutional review board approval, our institution’s
total joint registry database was used to identify patients
who had undergone RSA between 2014 and 2016 by 2 surgeons (J.S-S and M.E.M). Implants used included the Biomet Comprehensive reverse or Stryker ReUnion RSA,
which are both lateralized designs. The study began in2014 when both surgeons began using lateralized design
implants. Patients were included if they underwent primary RSA with at least 2 years of follow-up. Patients were
excluded if their index surgery at our institution was forrevision RSA. A total of 219 consecutive patients met thecriteria, and questionnaires were mailed to all potential
participants with a cover letter explaining the purpose of
the study as well as a consent form to be returned with thecompleted questionnaire in a prestamped, addressed envelope. To maximize the response rate, those who didn’t
respond received a second mailing 1 month later. Telephone reminders to nonresponders began 1 month after thesecond mailing. Telephone calls included 5 call attempts
before a person was considered a noncontact.
A total of 109 patients (65 women and 44 men) responded
to the survey, for a response rate of 50%. There was no
response from 65 patients, 40 patients refused to participation, 4 patients stated they were either physically or mentally unable to complete the survey, and 1 patient was
deceased. Of these 109 patients, 93 had undergone unilateral RSA (53 right shoulders and 40 left shoulders), and 16
patients had undergone bilateral RSA, for a total of 125
shoulders evaluated in this study. Ten shoulders were
replaced using the Biomet Comprehensive reverse implant,
and the remaining shoulders were replaced using the Stryker ReUnion RSA implant. The mean age at the time ofsurgery was 70 years (range, 34-86 years), and the mean

The Orthopaedic Journal of Sports Medicine

follow-up time was 3.9 years (range, 2-12 years). The maximum follow-up range reported extends beyond the study
period because 4 patients who underwent bilateral shoulder arthroplasties had 1 shoulder replaced before 2014. The
underlying diagnosis for the 125 shoulders included in thisstudy was cuff tear arthropathy in 65 shoulders, osteoarthritis in 30 shoulders, acute proximal humeral fracture in
9 shoulders, posttraumatic arthritis in 7 shoulders, fracture malunion in 5 shoulders, prior proximal humeral
resection in 3 shoulders, dislocation associated with large
cuff in 2 shoulders, failed prior internal fixation in 2
shoulders, rheumatoid arthritis with rotator cuff deficiency
in 1 shoulder, and steroid induced avascular necrosis in 1
shoulder.
All patients underwent a similar postoperative rehabilitation program. Shoulders were supported in a shoulder
immobilizer for 3 weeks postoperatively. At 3 weeks, passive and active assisted range of motion was initiated. Isometrics were added at week 8 and isotonic strengthening
exercises at week 10 to 12. At 3 months, lightweights(<10 lb) were allowed. After recovery from surgery (at 4-6
months), patients were allowed to perform higher levels ofactivity but were advised to avoid more than occasionallyheavier lifting (>25 lb) and to avoid activities with forcefulimpact.

Questionnaire Details
The methodology for this study was similar to that in previously published studies1,15,33 evaluating patient-reported
activities after anatomic TSA, HA, unilateral RSA, andbilateral RSA. A questionnaire was designed to evaluate
the current athletic activity and ability to return to sports
after reverse shoulder replacement. A previously assessed
patient questionnaire, providing high levels of agreementwith the surgeon’s assessment, included closed-ended questions that required a participant to fill in a circle withrespect to their operated shoulder.28 This included a pain
scale (0 represented no pain while 10 represented severepain), current use of pain medication (none, over the counter, narcotic, or both over the counter and narcotic), a diagrammatic representation of range of motion (forward
flexion in degrees, external rotation in degrees, and internal rotation scaled 1-8), and strength on a 10-point scale(where 0 is complete paralysis and 10 is normal strength).28
Added to the questionnaire were a choice of 43 sports
about which patients could indicate (1) whether they participated in them before and/or after surgery; (2) their ability to return to the same level of intensity, frequency, and†Address correspondence to Joaquin Sanchez-Sotelo, MD, PhD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA (email: sanchezsotelo.
joaquin@mayo.edu).
*Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Final revision submitted November 1, 2020; accepted January 10, 2021.
One or more of the authors has declared the following potential conflict of interest or source of funding: J.T. has received hospitality payments from
Synthes. C.L.C. has received educational payments and fees for services other than consulting from Arthrex. M.E.M. has received educational paymentsfrom Zimmer Biomet Holdings and Arthrex. J.S-S. has received consulting fees and royalties from Stryker, consulting fees and nonconsulting fees fromWright Medical Technology and Acumed, consulting fees from Exactech and Tornier, nonconsulting fees from Merck Sharp and Dohme Corporation, andeducational payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an
independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Ethical approval for this study was obtained from Mayo Clinic (study No. 19-002787).

The Orthopaedic Journal of Sports Medicine

duration of activity after surgery; (3) how soon they wereable to return to sport postoperatively; (4) if sports participation motivated them to undergo surgery; and (5) theirlevel of satisfaction with the function of their shoulder on a
10-point scale. For patients who could not return to sports,
they were queried as to (6) reasons why they could notparticipate in sports. Sports activities were categorized
subjectively by the authors into 3 groups, depending on theperceived demand on the shoulder replacement as low-,
medium-, and high-demand activities. A low-demand sport
involved activities that did not impose repetitive stress on
the shoulder and did not involve heavy lifting but involve
shoulder movements below shoulder height. A mediumdemand sport was defined as the potential for repetitive
stress, involving lifting loads up to 20 lb, and occasional
overhead activity. A high-demand sport involved activities
with repetitive stress, potential for loads >20 lb, and regular overhead movements (Table 1).

Statistical Analysis
Results from the questionnaire were tabulated, and statistical analysis was performed using SAS Version 8.2 (SASInstitute) by our Division of Biostatistics. Generalized estimating equations were used to assess the association
between returning to any sport (yes/no) and both laterality(unilateral vs bilateral) and demand of sport. This analysis
takes into account the fact that a patient may have participated in more than 1 sport and that, within a patient, one’s
response as to whether one returned to each sport may not
be independent of each other.

RESULTS
Return to Sports After Surgery
Of the 109 patients who responded to the survey, 81
patients indicated that they participated in sports before
undergoing an RSA. The overall mean rate of return tosports was 70.1%. The mean rate of return to sports forpatients with uni- and bilateral RSA were 68.9% and76.1%, respectively (odds ratio [OR], 0.70; 95% CI, 0.153.19; P ¼ .64). Sports with the highest number of postoperative participations included fishing (n ¼30), swimming (n¼ 22), elliptical/treadmill (n ¼ 19), and hunting (firearm orbow) (n ¼ 18) (Table 1). Patients who participated in yoga,
climbing, or Pilates preoperatively reported a 100% rate of
return to their sport postoperatively; however, the numberof patients in each sport was small. Activities with >75%
rate of return, in descending order, included sailing (92%),
fishing (91%), dancing (88%), weight training (88%), hiking(86%), elliptical/treadmill (86%), calisthenics (86%), hunting (82%), snowmobiling (80%), and snowshoeing (80%).
Rates of return to swimming were 73% and 60% for golf
and cycling, respectively. High-demand sports requiring
significant overhead stresses or throwing motions such as
basketball, tennis, volleyball, racquetball, and badminton
had 0% rate of return. The mean rate of return for highdemand sports (62.9%) was lower when compared with

Return to Sports After Primary RSA

3

TABLE 1
Patient-Reported Sports Participation Before
and After RSAa
Activity Level and Sport
Low-demand sports
Horseshoe throwing
Elliptical/treadmill
Snowshoeing
Medium-demand sports
Aerobics
Bowling
DancingFishing
Golf
HikingPilates
Running
Skiing/snowboarding
Swimming
Water aerobics
Yoga
High-demand sports
Archery
Badminton
Baseball/softball
Basketball
BoxingCalisthenics (bodyweight exercises)
Canoeing/kayaking/rowing
Climbing
Cycling/biking
American football
Gymnastics
Horseback riding
Hunting
Racquetball/handball
Sailing/boating
Skating/ice skating
Snowmobiling
TennisVolleyball
Weight traininga

Before
RSA

After
RSA

%
Return

2
22
5

1
19
4

50
86
80

11
15
16
33
20
22
2
9
5
30
9
3

8
7
14
30
12
19
2
5
1
22
6
3

73
47
88
91
60
86
100
56
20
73
67
100

5
2
8
5
0
14
18
4
25
1
1
4
22
1
12
5
10
3
2
8

2
0
1
0
1
12
12
4
15
0
1
2
18
0
11
1
8
0
0
7

40
0
13
0
NA
86
67
100
60
0
100
50
82
0
92
20
80
0
0
88

NA, not applicable; RSA, reverse shoulder arthroplasty.

return to low- and medium-demand sports (76.7%) (OR,0.52; 95% CI, 0.33-0.82; P ¼ .005). Table 2 summarizes thereturn to sports rate for each sport in patients with uni- andbilateral RSA.
In patients who underwent RSA for cuff tear arthropathy
or arthritis, the mean rate of return to sport was 74.5%. The
mean rate of return was 73.8% in patients with unilateral
RSA and 76.6% in patients with bilateral RSA (OR, 0.86;
95% CI, 0.17-4.34; P ¼ .86). The mean rate of return for
high-demand sports (68.6%) was also lower when comparedwith return to low- and medium-demand sports (80.1%)(OR, 0.54; 95% CI, 0.33-0.88; P ¼ .014).
Of those who returned to their sports activities postoperatively, a majority of patients reported being able to returnto the same level of preoperative intensity, frequency, andduration of sport (Figure 1). Of the total patients, 50% or4Tangtiphaiboontana et al

The Orthopaedic Journal of Sports Medicine

TABLE 2
Patient-Reported Sports Participation After Uni- andBilateral RSAa
Unilateral RSA

Activity Level and Sport
Low demand
Horseshoe throwing
Elliptical/treadmill
Snowshoeing
Medium demand
Aerobics
Bowling
DancingFishing
Golf
HikingPilates
Running
Skiing/snowboarding
Swimming
Water aerobics
Yoga
High demandArchery
Badminton
Baseball/softball
Basketball
BoxingCalisthenics (bodyweight
exercises)
Canoeing/kayaking/rowing
Climbing
Cycling/biking
American football
Gymnastics
Horseback riding
Hunting
Racquetball/handball
Sailing/boating
Skating/ice skating
Snowmobiling
TennisVolleyball
Weight training

Right
Side

Left
Side

Bilateral
RSA

1 (50)
9 (90)
1 (100)7 (88)
2 (67)

3 (75)
1 (100)5 (83)
4 (50)
8 (89)
14 (100)
3 (38)
9 (90)
1 (100)3 (40)0 (0)13 (76)
3 (75)
2 (100)3 (75)
1 (25)
6 (100)11 (79)5 (71)
6 (85)
1 (100)2 (67)
1 (33)
5 (63)
2 (50)
1 (100)0/1 (0)2 (67)
0/1 (0)5 (100)4 (80)
4 (80)

0/2 (0)0/2 (0)0/1 (0)0 (0)0/1 (0)0/1 (0)1
5 (83)

2 (100)0/1 (0)1 (33)
0/1 (0)3 (43)

2 (100)1 (100)3 (75)
0/2 (0)5 (83)
7 (78)
3 (100)8 (73)
1 (100)0/1 (0)6 (75)
4 (80)
0/1 (0)1 (50)
0/1 (0)0/1 (0)4 (80)

5 (50)

6 (75)
0/1 (0)2 (100)1 (33)
5 (83)
0/1 (0)1 (100)to participate in sports activities after surgery. Restrictedmotion (22%), fear of injury (21%), and weakness (18%)
were the most common reasons cited for inability to participate in sports.

Outcomes and Complications
Self-reported postoperative pain score, American Shoulder
and Elbow Surgeons score, shoulder motion, and strength
are summarized in Table 3. Mean (±SD) postoperative Subjective Shoulder Value were 76.7% ± 20% (range, 10-100%).
Shoulder satisfaction on a scale of 0 (no satisfaction) to 10(very satisfied) improved from a mean of 4.2 ± 3.9 preoperatively to 8.4 ± 2.1 postoperatively. Surgical complications
included acromial stress fractures treated nonoperatively(2 shoulders), hematoma (2 shoulders), with transient
ulnar neuropraxia (1 shoulder), and complex regional pain
syndrome (1 shoulder).

0/1 (0)4 (80)
1 (100)2 (100)1 (50)
6 (100)5 (100)2 (100)0/2 (0)2 (100)aData are reported as No. of patients (% return). Blank cells
indicate that no patient in this study practiced that particularsport before or after reverse shoulder arthroplasty. RSA, reverseshoulder arthroplasty.

less were able to return to the same level of intensity, frequency, and duration for swimming and climbing; 36% of
the patients reported that they were able to return to sports
4 to 6 months after surgery; 20% of the patients returned tosports between 6 months and 1 year; and 10% of thepatients returned after 1 year.
A minority of the study cohort (19 patients) reported that
their desire to participate in sports motivated their decision
to undergo a reverse shoulder replacement. Eighteenpatients reported that they were still limited and unable

DISCUSSION
The results of our survey study found an overall return tosports rate of 70.1% with no difference between those withuni- and bilateral RSA. Patients can expect to return to asimilar level of play with higher rates of return for low- andmedium-demand sports compared with high-demand
sports; however, none of our patients was able to returnto sports that required overhead rotational stress or
throwing.
There have been several studies3-5,14,19,27,31 assessing
sports activities after RSA. A study by Simovitch et al27
reported on the outcomes of 67 patients who participatedin high- or low-impact sports after RSA. They found that
60% of the patients were able to sports with a 7% rate ofcomplications. In contrast, Garcia et al9 reported a higher
rate of return to sport of 85.5% of a cohort of 76 patientswith RSA. Patients were able to return to sports fully by amean of 5.3 months, and 88.2% reported good to excellent
satisfaction with sports postoperatively. They also foundthat age > 70 years was a significant predictor of decrease
rate of return to sports. One explanation for the difference
between our results is that a majority of patients in ourcohort indicated that return to sports was not a motivating
factor to undergo surgery. This may have affected their
desire or attempt to play sports after surgery. We also
found lower rates of return to high-demand sports. Thiswas consistent with the findings reported by Fink Barnes
et al4 in a study of sports activities after RSA in 78 patients.
They found that 23.1% of the patients were able to participate in high-intensity sports, such as kayaking and skiing,
compared with 48.7% of the patients who were able to domoderate-intensity sports such as swimming or fishing.4
Patients with bilateral RSA had similar return to sport
rates compared with patients with unilateral RSA. Our
study is the first to report on sports activities in patientswith bilateral RSA. Previous studies evaluating function
after bilateral RSA have focused on ADLs. Levy et al16
found all 19 patients in their study were able to performperineal hygiene after RSA and most had no limitation in

The Orthopaedic Journal of Sports Medicine

Return to Sports After Primary RSA

5

Figure 1. Patient ability to return to preoperative levels of sports intensity, frequency, and duration after reverse shoulder arthroplasty (RSA).
TABLE 3
Postoperative Patient-Reported Clinical Data

Pain (0 [no pain] to 10 [severe pain])
Right
Left
ASES score (0-100)
Right
Left
Forward flexion, deg
Right
Left
External rotation, deg
Right
Left
Internal rotation (1-8a)
Right
Left
Strength (0-10)
Right
Left

Mean ± SD

Range

1.4 ± 1.2
1.2 ± 1.8

0 to 90 to 780 ± 1979 ± 1730 to 100
42 to 100161 ± 30
155 ± 32

40 to 180
60 to 180

52 ± 3348 ± 31–50 to 90–40 to 90

3.4 ± 1.9
3.6 ± 1.8

0 to 81 to 87.5 ± 27.2 ± 2

2-10
1-10

a

1 ¼ level of greater trochanter; 8 ¼ level of T3. ASES, American Shoulder and Elbow Surgeons.

ADLs or leisure activities. They also found improved rangeof motion in all planes including external and internal rotation. Assenmacher et al1 had similar findings in theircohort of 31 patients who underwent bilateral RSA except
limitation with activities that required extreme internalrotation, such as fastening a bra or washing their back.
Advances in implant design and surgical techniques continue to evolve with the goal of improving motion and function after RSA. Some studies report that a more lateralized
RSA improves both external and internal rotation andminimizes impingement on the scapula. However, 3 studies12,15,29 evaluating activity before and after RSA foundless difference in those with a lateralized center of rotationcompared with those with a medialized center of rotation.
Godin et al10 also evaluated the impact of subscapularis
repairability on return to sports after RSA and found thatpatients with reparable subscapularis tendons had higher
patient-reported outcomes and higher rates of return toactivities. Patients who had reparable subscapularis tendons had a return to sports rate of 89.8% compared with61.1% in patients with irreparable tendons.
Return to sports rates after RSA seem to be lower than
the rates reported after anatomic TSA, but variable whencompared with HA. A meta-analysis of 13 studies evaluating return to sports after shoulder arthroplasty found asignificantly higher rate of return after anatomic TSA(92.6%) compared with RSA (74.9%; P ¼ .003) and HA(71.1%; P ¼ .02).18 Another study by Wang et al32 foundthat 95% of the patients in the anatomic TSA group wereparticipating in at least 1 sport after surgery compared6

Tangtiphaiboontana et alwith 40% in the RSA group and 76% in the HA group. In a
study comparing 102 patients with RSA versus 71 patientswith HA, Liu et al17 found a higher rate of return to sports
in the RSA group compared with the HA group (86% vs67%; P ¼ .02, respectively). Patients in the RSA group werealso more satisfied with the ability to return to sports andhad a higher likelihood of returning to sport if they werefemale, age <70 years, had surgery on a dominant extremity, preoperative diagnosis of arthritis with rotator cuff dysfunction, and fewer postoperative complaints. Commonly
cited reasons for certain patients’ inability to participate
in sports activities after RSA have included medical comorbidities and shoulder limitations related to pain or stiffness. Postoperative restrictions for sports participation
may also be imposed or recommended by the treating surgeon.11,20 Golant et al11 found that only 45.2% of the surgeons felt comfortable allowing patients to return to sports
after RSA.
Sports participation can improve a patient’s quality oflife and may be a reason to undergo an RSA; however,increased demands on the implants, particularly withhigh-intensity or repetitive sports, may result in increased
wear, notching, and fracture. Demand on the shoulder also
varies with different activities, which may play a role in
implant survivorship. This is of particular concern in younger patients who want to remain active after surgery.
Although there are several studies3-5,14,17,19,31 evaluating
return to sports after RSA, the mean age of the patientsin these studies is older, they have short- to midterm
follow-up, and they are unable to comment on the longterm outcomes of sports on the longevity of the implant.
One study by Simovitch et al27 did include radiographic
evaluation in their study. In a cohort of 41 patients with amean age of 73 years and mean follow-up of 3.5 years, theyfound a 17% rate of radiographic lucency around thehumeral stem and a 7% rate of glenoid notching but nocases of humeral or glenoid loosening. Long-term studies
are needed to further assess the effects of postoperative
sports participation on the implant survivorship.
Our study has several limitations, including the retrospective nature of the study and potential for patient
recall bias. Surveys were conducted through mail, andalthough patients were contacted by telephone to remindthem to complete their survey, our survey response rate
was only 50%. This introduces the possibility of selection
bias, and our results may not representative of all patients
who undergo primary RSA. We also did not include a comparison group or radiographic review so we are unable tocomment on the effects of return to sports on the radiographic outcomes of RSA. Shoulder range of motion andstrength were measured by the patients as part of thesurvey questionnaire. The absence of radiographic outcomes may prevent surgeons from allowing their patientsto resume sports activities; however, no patient in ourstudy required revision shoulder surgery for implant failure, although most of our patients had <4 years of followup. Last, we did not perform a multivariate analysis toevaluate for the effect of age, sex, laterality, hand dominance, subscapularis tendon reparability, or preoperative
diagnosis on a patient’s ability to return to sports.

The Orthopaedic Journal of Sports Medicine

CONCLUSION
Patients undergoing primary RSA had a 70.1% rate of
return to sports with no significant difference in rates
between unilateral and bilateral RSA and no complications
related to sports that required additional surgery. The rateof return to high-demand sports such as tennis or basketball was lower compared with low- and medium-demand
sports such as fishing, swimming, or elliptical/treadmill;and no patients were able to return to overhead sports.
Additional long-term studies are needed to further assess
the potential for detrimental effects of continued sports
activities on the longevity and survivorship of the RSA.

REFERENCES
1. Assenmacher AT, Alentorn-Geli E, Aronowitz J, et al. Patient-reported
activities after bilateral reverse total shoulder arthoplasties. J Orthop
Surg (Hong Kong). 2019;27(1):2309499018816771.
2. Bülhoff M, Sattler P, Bruckner T, Loew M, Zeifang F, Raiss P. Do
patients return to sports and work after total shoulder replacement
surgery? Am J Sports Med. 2015;43(2):423-427.
3. Bülhoff M, Sowa B, Bruckner T, Zeifang F, Raiss P. Activity levels after
reverse shoulder arthroplasty. Arch Orthop Trauma Surg. 2016;136(9):1189-1193.
4. Fink Barnes LA, Grantham WJ, Meadows MC, Bigliani LU, Levine WN,
Ahmad CS. Sports activity after reverse total shoulder arthroplasty
with minimum 2-year follow-up. Am J Orthop (Belle Mead NJ).
2015;44(2):68-72.
5. Garcia G, Taylor SA, Mahony GT, et al. Patient activity levels after
reverse total shoulder arthroplasty: what are patients doing? Orthop
J Sports Med. 2015;3(7)(suppl 2):2325967115S00167.
6. Garcia GH, Liu JN, Mahony GT, et al. Hemiarthroplasty versus total
shoulder arthroplasty for shoulder osteoarthritis: a matched comparison of return to sports. Am J Sports Med. 2016;44(6):1417-1422.
7. Garcia GH, Liu JN, Sinatro A, et al. High satisfaction and return tosports after total shoulder arthroplasty in patients aged 55 years andyounger. Am J Sports Med. 2017;45(7):1664-1669.
8. Garcia GH, Mahony GT, Fabricant PD, et al. Sports- and work-related
outcomes after shoulder hemiarthroplasty. Am J Sports Med. 2016;44(2):490-496.
9. Garcia GH, Taylor SA, DePalma BJ, et al. Patient activity levels after
reverse total shoulder arthroplasty. Am J Sports Med. 2015;43(11):2816-2821.
10. Godin JA, Pogorzelski J, Horan MP, et al. Impact of age and subscapularis tendon reparability on return to recreational sports activities and2-year outcomes after reverse total shoulder arthroplasty. Orthop J
Sports Med. 2019;7(10):2325967119875461.
11. Golant A, Christoforou D, Zuckerman JD, Kwon YW. Return to sports
after shoulder arthroplasty: a survey of surgeons’ preferences.
J Shoulder Elbow Surg. 2012;21(4):554-560.
12. Kalouche I, Sevivas N, Wahegaonker A, Sauzieres P, Katz D, Valenti
P. Reverse shoulder arthroplasty: does reduced medialisation
improve radiological and clinical results? Acta Orthop Belg. 2009;75(2):158-166.
13. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;
93(24):2249-2254.
14. Kolling C, Borovac M, Audigé L, Mueller AM, Schwyzer HK. Return tosports after reverse shoulder arthroplasty—the Swiss perspective. Int
Orthop. 2018;42(5):1129-1135.
15. Lawrence TM, Ahmadi S, Sanchez-Sotelo J, Sperling JW, Cofield RH.
Patient reported activities after reverse shoulder arthroplasty: part II.
J Shoulder Elbow Surg. 2012;21(11):1464-1469.

The Orthopaedic Journal of Sports Medicine

16. Levy O, Walecka J, Arealis G, et al. Bilateral reverse total shoulder
arthroplasty—functional outcome and activities of daily living.
J Shoulder Elbow Surg. 2017;26(4):e85-e96.
17. Liu JN, Garcia GH, Mahony G, et al. Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total
shoulder replacement. J Shoulder Elbow Surg. 2016;25(6):920-926.
18. Liu JN, Steinhaus ME, Garcia GH, et al. Return to sport after shoulder
arthroplasty: a systematic review and meta-analysis. Knee SurgSports Traumatol Arthrosc. 2018;26(1):100-112.
19. MacInnes SJ, Mackie KE, Titchener A, Gibbons R, Wang AW. Activity
following reverse total shoulder arthroplasty: what should surgeons
be advising? Shoulder Elbow. 2019;11(2)(suppl):4-15.
20. Magnussen RA, Mallon WJ, Willems WJ, Moorman CT. Long-term
activity restrictions after shoulder arthroplasty: an international surveyof experienced shoulder surgeons. J Shoulder Elbow Surg. 2011;20(2):281-289.
21. Mannava S, Horan MP, Frangiamore SJ, et al. Return to recreational
sporting activities following total shoulder arthroplasty. Orthop J
Sports Med. 2018;6(7):2325967118782672.
22. McCarty EC, Marx RG, Maerz D, Altchek D, Warren RF. Sports participation after shoulder replacement surgery. Am J Sports Med.
2008;36(8):1577-1581.
23. Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder
arthroplasty for the treatment of irreparable rotator cuff tear without
glenohumeral arthritis. J Bone Joint Surg Am. 2010;92(15):2544-2556.
24. Padegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR,
Namdari S. Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res. 2015;473(6):1860-1867.

Return to Sports After Primary RSA

7

25. Schairer WW, Nwachukwu BU, Lyman S, Craig EV, Gulotta LV.
National utilization of reverse total shoulder arthroplasty in the UnitedStates. J Shoulder Elbow Surg. 2015;24(1):91-97.
26. Schumann K, Flury MP, Schwyzer HK, Simmen BR, Drerup S, Goldhahn J. Sports activity after anatomical total shoulder arthroplasty.
Am J Sports Med. 2010;38(10):2097-2105.
27. Simovitch RW, Gerard BK, Brees JA, Fullick R, Kearse JC. Outcomesof reverse total shoulder arthroplasty in a senior athletic population.
J Shoulder Elbow Surg. 2015;24(9):1481-1485.
28. Smith AM, Barnes SA, Sperling JW, Farrell CM, Cummings JD,
Cofield RH. Patient and physician-assessed shoulder function after
arthroplasty. J Bone Joint Surg Am. 2006;88(3):508-513.
29. Valenti P, Sauzières P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase motion and reduce notching? Clin Orthop Relat Res. 2011;469(9):2550-2557.
30. Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G.
Reverse total shoulder arthroplasty: a review of results according to
etiology. J Bone Joint Surg Am. 2007;89(7):1476-1485.
31. Wang A, Doyle T, Cunningham G, et al. Isokinetic shoulder strength
correlates with level of sports participation and functional activity after
reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2016;
25(9):1464-1469.
32. Wang J, Popchak A, Giugale J, Irrgang J, Lin A. Sports participation isan appropriate expectation for recreational athletes undergoingshoulder arthroplasty. Orthop J Sports Med. 2018;6(10):2325967118800666.
33. Zarkadas PC, Throckmorton TQ, Dahm DL, Sperling J, Schleck CD,
Cofield R. Patient reported activities after shoulder replacement:
total and hemiarthroplasty. J Shoulder Elbow Surg. 2011;20(2):273-280.