Hemiarthroplasty versus Total Shoulder Arthroplasty For Shoulder Osteoarthritis: A Matched Comparison of Return to Sports

OBJECTIVES: Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) in comparison to total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sport. The purpose of this study was to compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA). METHODS: A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and > 2 years of follow up. After inclusion criteria, all HA were statistically matched to a TSA patient by preoperative diagnosis, age (+/- 5 yrs), sex, and follow up period (+/- 6 months). At final follow up both cohorts completed a questionnaire regarding physical fitness and sporting activities. RESULTS: 40 HA and 40 TSA were available at final follow up. Average age at surgery was 65.7 years for HA and 66.2 year for TSA (p=0.06). Average follow up was 62.0 months for HA and 61.1 months for TSA (p=0.52). Average ASES scores improved for HA from 36.3 to 70.2 (p<0.001) and for TSA they improved from 34.0 to 78.5 (p<0.001). Final ASES scores were not significantly different between groups (p=0.21). Average VAS scores improved for HA from 6.3 to 2.2 (p<0.001), while TSA improved from 6.1 to 0.6 (p<0.001). HA patients had significantly worse final VAS scores compared to the TSA group (p=0.002). 70% (28) of HA patients compared to 15% (6) of TSA patients complained of postoperative problems with their shoulder (p<0.001). Significantly more TSA were satisfied with their surgery (p=0.01). 65.5% (19/29) of HA patients returned to at least one sport postoperatively compared to 97.3% (36/37) of TSA patients (p<0.001). Average timing for return to full sports was 5.5±4.2 months for HA and 5.4±3.1 months for TSA (p=0.92). Significantly more TSA patients returned to higher upper extremity use sports (p=0.01). CONCLUSION: In patients with OA, rate of return to sports was significantly better after TSA compared to HA. HA patients had significantly more pain, worse surgical satisfaction and decreased ability to return to high upper extremity use sports. For OA patients wishing to return to sporting activities, these result help manage expectations.