Isokinetic shoulder strength correlates with level of sports participation and functional activity after reverse total shoulder arthroplasty

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Background

Reverse total shoulder arthroplasty (RTSA) is increasingly being performed. Many patients may wish to return to high levels of sporting activity. This study aimed to evaluate the correlation of isokinetic shoulder strength with level of participation in sport and recreation after RTSA.

Methods

We surveyed 51 patients at a mean of 29.5 months (range, 12-60 months) after surgery. Mean age was 74.1 years. Patient-reported sporting activity was classified as low, medium, or high demand. All patients completed the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire and the Oxford Shoulder Score and underwent Biodex dynamometer testing of the RTSA evaluating isokinetic shoulder strength in flexion and extension, abduction and adduction, and internal and external rotation.

Results

Reported sporting activity was high demand in 35% and moderate demand in 43%. There was a large variation in shoulder isokinetic strength parameters especially for internal and external rotation. With the exception of abduction, a significant correlation was noted between strength and the level of sports participation that patients reported (P < .03). A significant correlation was also noted between strength and patient-reported outcome measures for internal rotation and arm flexion and abduction (P < .05).

Conclusion

Most patients reported returning to moderate- or high-level sporting activity in the short term after RTSA. Isokinetic shoulder strength, especially in internal rotation and arm flexion, positively correlates with both patient-reported level of participation in sports and recreation and daily function.

Section snippets

Methods

A retrospective study was performed of all patients having undergone RTSA by 1 of 2 experienced shoulder surgeons (A.W. and P.C.) during the period 2008 to 2013. During this period, 83 RTSAs were performed. Study inclusion criteria were age between 65 and 80 years at the time of surgery and a minimum of 12 months from the time of surgery to the time of evaluation. Formal physical therapy and supervised rehabilitation had ceased by the time of study recruitment in all patients. Exclusion

Patient characteristics

Of 69 patients identified and fulfilling the study inclusion and exclusion criteria, 51 patients consented to participate in the study. The average age at the time of surgery was 74.1 years. The mean follow-up time from surgery was 29.5 months. Of the 51 subjects, 27 (52%) were female; 49 (96%) of the subjects evaluated were right hand dominant. Surgery was performed on the right shoulder in 27 (53%) of the cases.

The indications for RTSA were rotator cuff arthropathy or massive cuff tear with

Discussion

Early studies of RTSA have reported high complication rates, and surgery was initially recommended for low-demand and older patients with the goals of restoring comfort and overhead motion.6, 8 The semiconstrained implant design and risk of accelerated polyethylene wear, scapular notching, and risk of implant failure have resulted in caution for surgeons performing RTSA in young and active patients.4, 6, 8 Golant et al,5 in a survey of 310 surgeons, reported that 74% of respondents allowed

Conclusion

In the short term after RTSA, 78% of patients had returned to moderate- or high-level recreational and sporting activity. This study finds that patients demonstrating greater isokinetic shoulder strength, especially in internal rotation and forward flexion, participate in higher demand recreational or sports activity and report fewer difficulties with activities of daily living.

Disclaimer

LIMA Corporate (Udine, Italy) provided financial assistance in the Biodex evaluation for this study.

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Acknowledgment

Dr Louise Sang assisted in the preparation of this manuscript.

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This research was approved by the University of Western Australia Human Research Ethics Committee (No. 2013-094).

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