Return to Sport and Long-term Performance Levels in Weight Lifters Treated for Advanced Glenohumeral Arthritis With...

Total shoulder arthroplasty (TSA) is challenging in weight lifters due to their relatively young age and desire for sport continuation.

This study aimed to assess return to weight lifting and long-term outcomes after inlay-TSA (iTSA). It was hypothesized that iTSA would lead to high return to sport and performance.

Case series; Level of evidence, 4.

This study included weight lifters (<65 years of age) with advanced osteoarthritis (OA) treated with iTSA (2011-2023). Radiographic analysis established glenoid morphology (Walch classification), OA grade (Samilson-Prieto classification system), humeral head centralization (Walch index; contact point ratio), and periprosthetic loosening (modified Lazarus grading system; clinically relevant radiolucency: complete line >2 mm). The primary outcome was return to sport. Secondary outcomes included weight lifting frequency, Western Ontario Osteoarthritis of the Shoulder Index (WOOS) percentage, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, satisfaction score, and range of motion (ROM). One-repetition maximum (1RM) and cumulative weight total (multiplying sets, repetitions, and weight lifted) were compared preoperatively and at the last follow-up on bench press (BP), overhead strict press (OSP; single arm and barbell), and military press (MP). The Wilcoxon rank-sum and paired t tests were used to compare preoperative and last follow-up functional and radiographic outcomes.

Eighteen male weight lifters (3 competitive, 15 recreational; 24 shoulders) with a mean age of 54.6 ± 6.8 years were included. Prearthritic weekly lifting frequency included ≥4 sessions (n = 16) or 2 to 3 sessions (n = 8). The mean follow-up was 83.5 ± 31.6 months. All athletes returned to weight lifting without restrictions at a median of 8.5 months (IQR, 6-24 months). Overall, 78% (n = 14) returned to the same or higher activity. The Cumulative lifetime maximum BP weight (preoperative: 6822.0 ± 2951.3 lb; postoperative: 5498.0 ± 2534.2 lb) was not significantly different (P = .177). Athletes returned to 73.4% ± 20.5% of their 1RM single-arm OSP (BP: 57.3% ± 21.8%; MP: 55.8% ± 23.3%). The final mean patient-reported outcomes were 81.7% ± 21.0% for WOOS percentage, 86.7 ± 16.9 for ASES score, 1.0 ± 2 for VAS pain score, and 8.8 ± 1.5 for satisfaction score. Preoperative ROM significantly improved in forward elevation (from 117.6°± 34.8° to 142.4°± 31.8°; P = .008) and external rotation (29.9°± 18.9° to 46.5°± 26.9°; P = .008). Centralization improved in the Walch index (from 0.58 ± 0.09 to 0.54 ± 0.05; P = .025) and contact point ratio (0.58 ± 0.08 to 0.51 ± 0.05; P < .001). Two glenoid components were removed due to posttraumatic injuries.

All athletes returned to weight lifting, with 78% returning to the same or higher activity. Weight lifters regained substantial performance levels at a mean of 74% of their prearthritic lifetime 1RMs. The long-term results support the treatment of advanced glenohumeral arthritis with iTSA for active patients.