JSES - 2026-07-01 - Journal Article; Multicenter Study
Return to weightlifting after shoulder arthroplasty: an ASES multicenter study predicting performance after reverse shoulder arthroplasty and anatomic shoulder arthroplasty.
Diestel DR, Sudah S, Veale N, Arnold R, Corban J, Kirsch JM, Bowler A, Glass EA, Gray SE, McDonald-Stahl M, Stevens CS, Puzzitiello R, Moverman MA, Le K, Dunn W, Jawa A, ASES Multicenter Research Group
Topics
Key Takeaway
93.1% of weightlifters returned to sport after shoulder arthroplasty at mean 23.3 months, with rTSA patients more likely to maintain or increase training frequency than aTSA patients (90.7% vs. 72.2%, P=.026).
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Summary
This multicenter ASES study examined return-to-weightlifting rates, exercise-specific performance, and PROs in 175 patients after rTSA or aTSA using sport-specific questionnaires and Delphi-consensus parameters. Overall, 93.1% returned to weightlifting and 79.4% maintained or improved performance, with most returning by 3–12 months. Propensity-matched rTSA vs. aTSA for GHOA showed comparable return rates but rTSA patients had superior deltoid raise improvement (82.6% vs. 50.0%, P=.020) and higher frequency maintenance; within rTSA, GHOA patients outperformed rotator cuff arthropathy patients on enjoyment and participation frequency.
Key Limitation
Absence of objective load-based performance data (e.g., one-rep max, training volume) means 'maintained or improved performance' relies entirely on patient self-report, which cannot distinguish true functional recovery from activity modification or lowered expectations.
Original Abstract
BACKGROUND
Return to sport and sport-specific performance following shoulder arthroplasty are not well-characterized, particularly in strength-based activities such as weightlifting. This study evaluates return-to-weightlifting rates, exercise-specific performance, and patient-reported outcomes following reverse shoulder arthroplasty (rTSA) and anatomic shoulder arthroplasty (aTSA).
METHODS
We conducted a multicenter analysis of patients from 24 American Shoulder Elbow Society (ASES) surgeons across 17 institutions who underwent rTSA or aTSA and completed sport-specific return to sport questionnaires. Study parameters were defined by the Delphi method, requiring 75% agreement for consensus. Data collected included pre- and post-operative participation, timing of return, and patient-reported outcomes on performance, frequency, enjoyment, and satisfaction relative to pre-operative status. Specific weightlifting abilities (bench press, bicep curl, overhead press, deltoid raise, and pushups) were assessed. Subgroup analyses included age- and sex-matched comparisons of rTSA and aTSA for glenohumeral osteoarthritis (GHOA) and rTSA for GHOA vs. rotator cuff arthropathy. Statistical analyses included t-tests, chi-square or Fisher exact test, and multivariable logistic regression. Statistical significance was set at P < .05.
RESULTS
Among 175 weightlifters (mean follow-up of 23.3 ± 7.6 months), 93.1% returned to weightlifting and 79.4% reported maintained or improved performance. Most returned by 3-6 months (39.3%), with an additional 29.5% returning by 7-12 months. Propensity-matched analysis of 54 rTSA patients and 54 aTSA patients for GHOA found similar return rates (rTSA: 98.1% vs. aTSA: 96.3%, P > .999) and likelihood of improved or maintained performance (rTSA: 90.7% vs. aTSA: 79.6%, P = .176). However, rTSA patients were more likely to maintain or increase weightlifting frequency (90.7% vs. 72.2%, P = .026) and had higher improvement in deltoid raise ability (82.6% vs. 50.0%, P = .020). No significant differences were found in bench press, overhead press, biceps curls, or pushups. Within the rTSA cohort, GHOA patients reported greater post-operative enjoyment (95.6% vs. 76.0%, P = .021) and a percent who improved or maintained frequency (86.7% vs. 60.0%, P = .025) compared to rotator cuff arthropathy patients. Multivariate regression found no significant predictors of worse post-operative performance (all P > .05).
CONCLUSION
Most patients resume weightlifting after shoulder arthroplasty, often maintaining or improving performance. Although outcomes are comparable by arthroplasty type, rTSA may afford better deltoid function and increased participation frequency. Additionally, pre-operative diagnosis appears to influence enjoyment and engagement following rTSA, despite similar improvements across specific exercises. These findings highlight the complex nature of recovery and the value of personalized pre-operative counseling.