Return to sport after shoulder arthroplasty: an ASES multicenter analysis of sport-specific predictors of performance in reverse shoulder arthroplasty and total shoulder arthroplasty

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-specific and sport-specific factors associated with postoperative athletic performance. A multicenter retrospective analysis with prospective administration of RTS questionnaires was conducted among patients who underwent rTSA or aTSA between 1 and 3 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. 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. 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.