RETURN TO WORK FOLLOWING SHOULDER ARTHROPLASTY: A SYSTEMATIC REVIEW
Figure 1 - Flow diagram illustrating systematic literature review process.
Background: Many patients prioritize the ability to return to work (RTW) after shoulder replacement surgeries such as total shoulder arthroplasty (TSA), reverse TSA (rTSA), and shoulder hemiarthroplasty (HA). Due to satisfactory clinical and functional long-term outcomes, the number of shoulder replacements performed will continue to rise into this next decade. With younger individuals who compose a significant amount of the workforce receiving shoulder replacements, patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.
Aim: To summarize RTW outcomes following TSA, rTSA, and HA, and analyze the effects of workers' compensation status on RTW rates and ability.
MINORS: Methodological Index for Non-Randomized Studies; HHA: Humeral hemiarthroplasty; rTSA: Reverse total shoulder arthroplasty; NR: Not reported; NA: Not available; Hemi RR: Hemiarthroplasty with ream-and-run resurfacing; aTSA: Anatomic total shoulder arthroplasty.
Methods: This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search regarding RTW following shoulder arthroplasty was performed using four databases (PubMed, Scopus, Embase, and Cochrane Library), and the Reference Citation Analysis (https://www.referencecitationanalysis.com/). All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included. Nonclinical studies, literature reviews, case reports, and those not reporting on RTW after shoulder arthroplasty were excluded.
Numbers are relevant to groups who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty.
OA: Osteoarthritis; CTA: Cuff tear arthropathy; RCT: Rotator cuff tear; PHFx: Proximal humerus fracture; RA: Rheumatoid arthritis; AVN: Avascular necrosis; aTSA: Anatomic total shoulder arthroplasty; rTSA: Reverse total shoulder arthroplasty; HHA: Humeral hemiarthroplasty; TSA: Total shoulder arthroplasty; NR: Not reported; WC: Workers' compensation; NWC: Non-workers compensation; OR: Operating room.
Excluding those who were retired preoperatively, retired due to medical concerns, or retired due to non-specified reasons.
Only includes individuals who responded to question 10 of the ASES questionnaire in regards to work.
Numbers are relevant to groups who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty.
M: Male; F: Female; BMI: Body mass index; WC: Workers' compensation; NWC: Non-workers' compensation; RTW: Return to work; NR: Not reported; aTSA: Anatomic total shoulder arthroplasty; rTSA: Reverse total shoulder arthroplasty; HHA: Humeral hemiarthroplasty.
Results: The majority of patients undergoing TSA, rTSA, or HA were able to RTW between one to four months, depending on work demand stratification. While sedentary or light demand jobs generally have higher rates of RTW, moderate or heavy demand jobs tend to have poorer rates of return. The rates of RTW following TSA (71%-93%) were consistently higher than those reported for HA (69%-82%) and rTSA (56%-65%). Furthermore, workers' compensation status negatively influenced clinical outcomes following shoulder arthroplasty. Through a pooled means analysis, we proposed guidelines for the average time to RTW after TSA, rTSA, and HA. For TSA, rTSA, and HA, the average time to RTW regardless of work demand stratification was 1.93 ± 3.74 mo, 2.3 ± 2.4 mo, and 2.29 ± 3.66 mo, respectively.
Conclusion: The majority of patients are able to RTW following shoulder arthroplasty. Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.
Click on the link for the full print article:
Return to work following shoulder arthroplasty: A systematic review - PMC (nih.gov)
Published September 18, 2022 in the World Journal of Orthopaedics.