Against surgeons’ advice: the return to sport in high-demand weightlifters following anatomic total shoulder arthroplasty at average 3.6 years’ follow-up

Abstract

BackgroundReturn to sport in high-demand weightlifters following total shoulder arthroplasty has rarely been investigated, as most surgeons recommend against returning to heavy lifting postoperatively. The purpose of this study is to determine the incidence of return to sport, patient-reported outcomes, patient satisfaction, performance, and failures in a specific population of high-demand weightlifters that continue lifting after undergoing total shoulder arthroplasty.MethodsRetrospective review of a specific population of high-demand weightlifters that underwent anatomic total shoulder arthroplasty with minimum 1-year clinical follow-up was conducted. Prospective surveys determining pre- and postoperative participation in weightlifting included maximum weight, frequency, and duration of workouts, Single Assessment Numeric Evaluation (SANE), patient satisfaction, and postoperative range of motion were collected. Secondary outcomes included failure, revision surgery, risk factors for not returning to weightlifting, and performance measured as both absolute value and percentage of prior maximum weight lifted in different exercises. Bivariate and multivariate analysis was performed to compare cohorts and identify risk factors, respectively.ResultsForty-two shoulders in 36 patients who met inclusion criteria (average age 57.9 years, standard deviation [SD] 8.0 years, 97% male) comprised the sample. No patient underwent revision surgery at average 3.6 years' follow-up (1-7 years, SD 1.9 years). The majority of patients (23/42 shoulders) report returning to heavy weightlifting postoperatively against senior surgeon's recommendations. Mean SANE score for current weightlifters and retired weightlifters were 86.9 and 91.6, respectively (P = .148). In the weightlifting cohort, only 78.3% of patients achieved patient-acceptable symptom state PASS threshold for SANE compared with 89.5% of patients (P = .332) in the retired cohort. Patient satisfaction and return to sport satisfaction in current weightlifting shoulders were good to excellent in 91.3% (P = .922) and 82.6% (P = .972), respectively. Patients who continued lifting reported substantially decreased maximum weight in all lifts compared with the presymptomatic maximum.ConclusionThese data provide insight for surgeons on the expected activity level of prior high-demand weightlifters. Most patients who participated in preoperative weightlifting returned to high-demand weightlifting after surgery against their surgeon's recommendations, but patients demonstrated lower lifting performance postoperatively. There were no early clinical catastrophic failures, with high patient-reported outcomes. Although caution is still advised with returning to heavy weightlifting, the current data highlight the advances of modern fixation techniques, fourth-generation implants, and diminished lifting capacity after surgery, which likely play a role in the high implant survivorship in this cohort.

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