Many of the clinic, hospital, physician, and therapy websites sponsored by folks who specialize in shoulder surgery feature a patient who, having had "the" surgery, has returned to playing golf, tennis, swimming, etc and is doing very well. That got me to wondering if there is a protocol defining what activities the recovering or recovered rTSA (reverse total shoulder arthroplasty) surgery patient can and cannot do. The answer is not formally but there is a consensus.
In 2011 orthopedic doctors from Duke University, NC and Onze Lieve Vrouwe Gasthuis Hospital in Amsterdam, Holland published in the Journal of Shoulder and Elbow Surgery the results of a survey of one hundred one orthopedic surgeons. The physicians were provided a list of thirty-seven athletic activities and were asked if they approved of the activity for the three categories of patients: those who had undergone Hemiarthroplasty, those with total shoulder replacement arthroplasty, and reverse total shoulder arthroplasty patients. The approval or disapproval could be recommended based on the patient's experience in the sport prior to surgery.
Hemiarthroplasty patients were generally considered to be at their maximum activity level between two and seven months post op. Total shoulder replacement patients were, likewise, considered ready for full activity between two and seven months, leaning somewhat on the longer time period. As one would expect, rTSA patients were considered ready for full activity a little farther out but beginning as early as four to seven months post op and extending as long as twelve months.
The Hemiarthroplasty patient faced the least restriction as they resumed physical activity. Swimming, jogging, golf, low impact aerobics, walking and dancing received approval from over 90% of the respondents. Raquetball, tennis, soccer, volleyball, ice skating and baseball were acceptable activities generally if the person had previous experience in those sports. But football, snow boarding, downhill skiing, lacrosse, and martial arts were generally not recommended.
Total shoulder arthroplasty patients, as you would guess, were somewhat more restricted. Doubles tennis was preferred over singles, sprint oriented track and field was more acceptable than throwing events. Raquetball, basketball, volleyball and team handball received only modest support from approximately 30% of the survey participants. Again football, martial arts, weight lifting, snowboarding, lacrosse, water skiing, team handball, and ice skating were discouraged, more by the European respondents than by the North American doctors.
Reverse Total Shoulder arthroplasty was met with much greater restriction. Jogging, walking, stationary bicycling, and ballroom dancing were the only activities that received general approval. With an experienced patient, low impact activities like hiking, golf, cross country skiing, and table tennis received modest support. Bowling, downhill skiing, rowing, even doubles tennis were not recommended by a majority of the physicians. The question of using the non operated arm/shoulder for an activity, say bowling, was not suggested nor addressed. I would think that would make a difference.
The conclusion was that restrictions were based on the type of surgery the patient underwent. European surgeons tended to be more conservative in approving various activities, especially among rTSA patients. The study did not raise this issue but I wonder if we shouldn't give greater consideration to the European attitude since they have a much longer history of performing reverse shoulder procedures. North American doctors have not quite ten years of follow up for rTSA patients. Our doctors in the US tend to predict the rTSA prosthesis will "last"seven to ten years. European websites infer longer life for the device, even fifteen to twenty years has been suggested. Is it possible lesser physical activity could extend the life of the implant and delay revision surgery?
Is this the perfect excuse to become a couch potato?
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically..
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