I'd like to say thank you to my co-authors for the opportunity to present, as well as the Society for having me here present my paper, Returning to High-Demand Weightlifting After Shoulder Arthroplasty. These are my disclosures. The background for this study, as we know, the incidence of shoulder arthroplasty is increasing nationally. Much of the buzz has been about reverse, but as younger and younger patients are getting shoulder arthroplasty, the incidence of anatomic is also increasing, and the indications are expanding. We know from studies in the elderly population that there's a very good return to sport of approximately 70 percent after shoulder arthroplasty, but satisfaction has been less predictable in younger patients, and there's no data presently prior to this study on return to sport for high-demand athletes after anatomic shoulder arthroplasty. The current state for post-op restrictions, a consensus was reached among ASES surgeons that certain sports may accelerate total shoulder component wear. Specifically, they highlighted weightlifting, baseball, softball, lacrosse, rowing, and soccer as being concerning activities after shoulder replacement, and 57 percent recommended against weightlifting after a total shoulder arthroplasty. There's only one study that looks at shoulder arthroplasty return to sport under 55, and they poorly define weightlifting as resistance-band activities and high-repetition, low-weightlifting activities. Our current senior surgeon recommendations on this study was maximum 50-pound weightlifting below shoulder and 30 pounds overhead after surgery and full recovery. We sought to determine whether or not the incidence of return to sport in these high-demand weightlifters and to evaluate their clinical failures, reported outcomes, and satisfaction levels. This was a level four retrospective cohort study where we evaluated 42 shoulders in 36 patients, with six patients having undergone bilateral shoulder replacement, average age about 58 years, and being almost entirely male. Our average follow-up was 3.6 years. We're now approaching nine years on this study. And inclusion criteria included patients that met the master's division qualifying totals for weightlifting with 200-pound greater bench and shoulder press and more than 135 pounds for female athletes who lifted at least three days per week preoperatively or who competed in professionally shanked events. We excluded patients when it went reverse or had a shoulder resurfacing or had another concomitant surgery at the time. We collected their demographic information, the type of implant which was uniform throughout the study, pre- and postoperative range of motion, whether or not they had a prior steroid injection, their satisfaction scores, postoperative SANE scores, and weightlifting metrics. We administered a question survey which was administered via email. If they didn't respond to emails, we called them. How much they were able to lift before their symptoms had begun, we thought it was important to stratify pre-symptomatic and post-symptomatic state and then evaluate that compared to their postoperative state. Were you lifting immediately before surgery or not? And then were you competing? We asked them to self-report their weights that they were doing for these three activities, shoulder press, bench press, and lat pull down, how many days and hours they were at the gym, and if they had any other surgeries done since their shoulder arthroplasty. We then asked them to grade their satisfaction overall and then with their return to sport and then obtain their SANE score. Our results were quite good. We indicated 86% of patients were able to return to sport after shoulder arthroplasty with 64% able to return to weightlifting, 86.9% of the weightlifters, and interestingly a little more, 91% of the non-lifters achieved a SANE score of, sorry, their SANE scores were 86 and 91% respectively. The PASS threshold for SANE, 78% was reached, about 91% were within half a point of that. There is no PASS score for young patients that return to weightlifting, so we used the average, 75.5, for return, for satisfaction, patient acceptable satisfaction after shoulder arthroplasty in an elderly cohort with an average age of 70. 91% of patients were satisfied with good to excellent satisfaction, and there was no difference, clinically important difference in their range of motion post-operatively. Interestingly, there was a significant difference in their lifting performance at follow-up and even patients who were very satisfied with their surgery lifted much less weight after surgery. So compared to their preoperative symptom state, they lifted about 50% on average bench press and shoulder press, but were able to achieve about 80% of their lat pull-down strength. You can see on the right here the bench press pre-op with symptoms and post-op without symptoms. Quite a bit of difference, but still nonetheless they were able to do it. Interestingly five patients in this study that had resigned weightlifting before surgery were able to resume weightlifting afterwards. We had 13 patients who did not return to weightlifting after surgery. They recited some of them were good and followed their post-op restrictions. Most of them just said that they had some other issue that they didn't do it for. And so despite surgeons' recommendations, we thought it was important to highlight that many patients will resume weightlifting without functional detriment early. We had no catastrophic clinical failures at 3.6-year follow-up. We did comment slightly on this push-pull phenomenon in that the bench press and shoulder press was substantially less than the lat pull-down. It may be due to the inherent nature of the surgery where we released some of the biceps and some of the pectoralis major to gain access to the shoulder as part of the procedure, whereas the triceps and posterior base structures are not injured. At present our data does not support altering post-operative restrictions, but we do think that surgeons should be aware of what their patients are likely going to return to if you choose to go down this path with them. Our study was not without limitations. We looked at frank revisions as opposed to radiolucent lines or Lazarus classifications. It was retrospective in nature of a single surgeon database and was certainly subject to recall and embellishment bias by patients self-reporting more weight than they were actually able to lift. There is no MCID or SCB established for this patient cohort, and we were unable to comment on that. And we had a relatively short three-and-a-half-year follow-up, although we're now approaching nine years with no failures. These are my references. Thank you. ________________

Returning to High-Demand Weightlifting After Shoulder Arthroplasty

shoulder arthroplasty

return to sport rate

weightlifters

patient satisfaction