JSES - 2026-04-01 - Journal Article
Return to Sport After Shoulder Arthroplasty: An ASES Multicenter Analysis of Sport-Specific Predictors of Performance in Reverse Shoulder Arthroplasty and Total Shoulder Arthroplasty.
Corban J, Kirsch JM, Bowler A, Glass EA, Diestel DR, Arnold RP, McDonald-Stahl M, Stevens CS, Puzzitiello R, Moverman MA, Le K, Dunn W, Jawa A, ASES Multicenter Research Group
Topics
Key Takeaway
89.2% of shoulder arthroplasty patients returned to sport with 80.2% reporting maintained or improved performance, and rTSA demonstrated superior sport performance stability versus aTSA in matched GHOA patients (87.9% vs 78.9%, P=0.039).
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Summary
This multicenter ASES study across 17 U.S. institutions examined RTS rates and sport-specific performance outcomes in rTSA and aTSA patients 1–3 years postoperatively using prospectively administered questionnaires and Delphi-defined parameters. Overall RTS was 89.2% across seven sports, with weightlifting (93.1%), tennis (92.3%), and running (92.9%) highest; 44.7% returned within 3–6 months. In propensity-matched GHOA cohorts, rTSA outperformed aTSA on sport performance stability (87.9% vs 78.9%, P=0.039) and satisfaction (P=0.007), while GHOA diagnosis (OR 0.20) and post-capsulorrhaphy arthropathy (OR 0.07) independently predicted lower odds of worsened performance.
Key Limitation
The study lacks objective preoperative and postoperative sport performance measures, making it impossible to distinguish true performance recovery from patient-perceived adaptation to a lower functional baseline.
Original Abstract
INTRODUCTION
Many patients undergoing shoulder arthroplasty - either reverse shoulder arthroplasty (rTSA) or anatomic shoulder arthroplasty (aTSA) - strongly desire to return to sport, yet return-to-sport (RTS) outcomes remain incompletely defined. This study aimed to determine RTS rates following rTSA and aTSA and to identify patient- and sport-specific factors associated with postoperative athletic performance.
METHODS
A multicenter retrospective analysis with prospective administration of RTS questionnaires was conducted among patients who underwent rTSA or aTSA between one and three years postoperatively. Twenty-four ASES surgeons from 17 U.S. institutions participated. Study design and parameters were defined using a Delphi consensus method. The RTS questionnaire assessed participation in seven sports: golf, pickleball, tennis, running, weightlifting, yoga, and swimming. Outcomes included RTS status, changes in performance, enjoyment, participation frequency, time to RTS, and shoulder satisfaction (0-10). Univariate ANOVA compared outcomes across sports. Two age- and gender-matched propensity score analyses compared (1) rTSA versus aTSA for glenohumeral osteoarthritis (GHOA) and (2) rTSA for GHOA versus rotator cuff arthropathy (RCA). Multivariate logistic regression identified predictors of worse postoperative performance.
RESULTS
A total of 961 patients completed the questionnaire; 55.9% (n=537) participated in at least one sport preoperatively and attempted RTS postoperatively, yielding 656 sport participations. Mean follow-up was 24.0 ± 8.1 months, mean age was 68.3 ± 8.2 years, mean BMI was 28.5 ± 5.8, and 65.6% were male. Across all sports, 89.2% of participants were still playing, and 80.2% reported improved or unchanged performance, with no differences between sports. Overall RTS rates were highest for running (92.9%), tennis (92.3%), and weightlifting (93.1%). Most patients returned within 3-6 months (44.7%). In matched GHOA cohorts (n=165 each), rTSA demonstrated higher rates of improved or stable performance (87.9% vs 78.9%, P=0.039) and greater satisfaction (P=0.007) compared to aTSA, with similar RTS rates (93.3% vs 89.1%). Diagnosis of GHOA (OR 0.20, P=0.001) and post capsulorrhaphy arthropathy (OR 0.07, P=0.021) were independently associated with lower odds of worsened postoperative sport performance.
CONCLUSION
Return to sport following shoulder arthroplasty is high, with most patients reporting maintained or improved performance. In patients with GHOA, rTSA was associated with higher rates of improved or stable sport performance and greater satisfaction compared to aTSA.