Sunday, July 19, 2009
The New York Times has a very interesting presentation that can be viewed here.
Thursday, July 16, 2009
It is more likely than not that active individuals can return to their preoperative level of sports participation following total shoulder arthroplasty, according to a study presented here.
Approximately 94% of patients will return to sports, and 86% will return to their preoperative sport -- 80% at the preoperative intensity according to a study presented at the American Society for Sports Medicine 2009 Annual Meeting. Unrestricted activity can be allowed at 6 months, and low-impact low sports are suggested.
Return to sport may become a benchmark of these arthroplasty surgeries.
To assess activity levels following total shoulder arthroplasty (TSA), researchers sent questionnaires to 304 patients who received unconstrained TSA; 165 questionnaires were returned and 87 of those patients indicated that they regularly participated in sports.
The average age was 58.5 years and the minimum follow-up was 1 year. Preoperative diagnosis was commonly osteoarthritis, but they also saw rheumatoid arthritis and osteonecrosis.
The patients received the same prosthesis, which had an anatomic stem and a cemented all-polyethylene glenoid component. All patients received a tenotomy or tenodesis procedure.
Rehabilitation involved light swim at 1 to 2 weeks, active external rotation at 4 weeks, water therapy at 5 to 8 weeks, and unrestricted activity beyond 6 months. Restricted behavior before 6 months included putting, half-swing golf shots from the tee at 3 months and full swing at 4 months.
The preoperative sports that patients participated in included walking, hunting and fishing, golf, swimming, cycling, aerobics, tennis, jogging and waterskiing.
At minimum 1 year follow-up, 94.4% said they returned to the sport, with 86% returning to the sport they played preoperatively, and 80% who did return reported the same intensity they had preoperatively.
In terms of postoperative pain, 74% reported no postoperative pain with sports participation, 75% reported no pain after sports participation and 82% reported using no pain medication for any pain related to sport participation.
The subscapularis function is critical in trying to understand if the 80% [return-to-same-intensity rate] would be higher. We know that if they are having subscapularis failures, that can compromise their function.
Return to sports does not mean return to unrestricted overhead work. One must be very careful not to expect to return to unrestricted to overhead manual labor after a shoulder replacement.
- Drake G, Gibson V, Elkousy H, et al. Resuming sports after total shoulder arthroplasty – Is it viable? Presented at the American Society for Sports Medicine 2009 Annual Meeting. June 9-12, 2009. Keystone, Colo.