Paper 58: Against Surgeons’ Advice: The Return to Sport in High Demand Weightlifters Following Anatomic Total Shoulder Arthroplasty at Average 3.6 Years Follow-up

OBJECTIVES: Return to sport in high-demand weightlifters following total shoulder arthroplasty has rarely been investigated, as most surgeons recommend against returning to heavy lifting postoperatively. The purpose of this study is to determine the incidence of return to sport, patient reported outcomes, patient satisfaction, performance, and failures in a specific population of high demand weightlifters that continue lifting after undergoing total shoulder arthroplasty. METHODS: Retrospective review of a specific population of high demand weightlifters that underwent anatomic total shoulder arthroplasty with minimum one-year clinical follow up was conducted. Prospective surveys determining pre- and postoperative participation in weightlifting included maximum weight, frequency, and duration of workouts, Single Assessment Numeric Evaluation (SANE), patient satisfaction, and post-operative range of motion were collected. Secondary outcomes included failure, revision surgery, risk factors for not returning to weightlifting, and performance measured as percentage of prior maximum bench press. Bivariate and multivariate analysis was performed to compare cohorts and identify risk factors, respectively. RESULTS: Forty-two shoulders in 36 patients who met inclusion criteria (avg age 57.9 years, 97% male). No patient underwent revision surgery at average 3.6 year follow up (1 to 7 years, SD 1.9 years). The majority of patients (23/42 shoulders) report returning to heavy weightlifting postoperatively against senior surgeon’s recommendations. Mean SANE score for current weightlifters and retired weightlifters were 86.9 and 91.6, respectively (P = 0.148). In the weightlifting cohort, only 78.3% of patients achieved patient-acceptable symptom state (PASS) threshold for SANE compared to 89.5% of patients (p = .332) in the retired cohort. Patient satisfaction and return to sport satisfaction in current weightlifting shoulders were good-to-excellent in 91.3% (P= 0.922) and 82.6% (P = 0.972) respectively. Patients who continued lifting reported substantially decreased maximum weight in all lifts compared to pre symptomatic maximum. CONCLUSIONS: This data provides insight for surgeons on the expected activity level of prior high demand weightlifters. Against their surgeon’s recommendations, most patients who participated in preoperative weightlifting returned to high demand weightlifting after surgery, but patients demonstrated lower lifting performance postoperatively. There were no early clinical catastrophic failures with high patient reported outcomes. While caution is still advised with returning to heavy weightlifting, the current data highlights the advances of modern fixation techniques, fourth generations implants, and diminished lifting capacity after surgery, which likely play a role in the high implant survivorship in this cohort.