Recreation After Shoulder Arthroplasty: A Conversation with Dr. Samer Hasan

Editor’s note: During the upcoming 30th Annual Tampa Shoulder Course: Arthroplasty & Sports, Dr. Samer Hasan will speak on the topic, Recreational Activity After Shoulder Arthroplasty: Do I Limit My Patients, and If So, How? We asked Dr. Hasan to preview the key points he’ll make in his presentation.

FORE: One of your presentations will be on recreational activity after shoulder replacement. Why is it important to include this topic in the agenda for the Tampa Shoulder Course?

Samer S. Hasan, MD, PhD: Activity after shoulder replacement surgery, including recreational activity, is an important topic because every surgeon and every patient has expectations about postoperative activity, and ideally these expectations are in alignment.

This has been a hot topic for more than a decade and the subject of numerous clinical studies and systematic reviews. There is a critical mass of data out there that should form the basis for a thoughtful review and discussion on return to recreational activity after either anatomic or reverse shoulder replacement.

RELATED: Register for the 30th Annual Tampa Shoulder Course, February 1-3, 2024

FORE: What limitations do you put on your patients’ recreational activities post-shoulder arthroplasty? What factors do you consider in making these recommendations – for example, patient age, type of procedure, type of activity? And how do patients typically respond?

Dr. Hasan: I don’t set any absolute restrictions on recreational activities after shoulder replacement. My patients have experienced fewer complications related to sports participation, including activities that would be generally perceived as being higher risk, than complications resulting from a fall or related to gross noncompliance early in the postoperative period.

However, I do try and set expectations regarding the recovery cadence, so that patient who plan to resume swimming or golfing understand that the process takes 4 to 6 months, and not 4 to 6 weeks.

In general, I prefer that patients undergoing reverse shoulder arthroplasty avoid high-impact sports, such as ice hockey, or heavy weight training because of concerns over the potential for a dislocation or increased stresses at the bone implant interface. At the same time, I have retirees with bilateral reverse shoulder arthroplasties who volunteer building houses and are always climbing ladders or roofs, so it is irrational to think we can eliminate risk.

In addition , for younger patients desiring to return to strenuous lifting activities, I selectively perform the ream-and-run procedure – which comprises hemiarthroplasty combined with concentric glenoid reaming and reshaping. Avoiding a glenoid component eliminates the risk of late glenoid component loosening.

Consequently, I encourage these younger patients to resume full activities without reservation once the subscapularis tendon has healed well, or around 6 months postoperatively. Many of my younger patients have resumed heavy weight training, coaching football, farming, and heavy manufacturing and warehousing jobs without any functional deficits.

FORE: What guidance does the literature provide for discussion about return to activity, including limitations and timelines?

Dr. Hasan: The most salient findings in the literature relate to the likelihood of returning to various sports following shoulder replacement, including both anatomic and reverse shoulder replacement. These can help manage expectations for patients who are considering shoulder replacement surgery.

A few authors have recommended specific weight restrictions for reverse shoulder arthroplasty, but my own experience tells me that patients typically resume doing what they think they can do.

FORE: What are the key points you want attendees to take away about your presentation?

Dr. Hasan: Surgeons in the US and worldwide are performing more and more shoulder replacements because of changing patient expectations, more implant options with expanded indications, refinements in techniques, and proven durability.

Many patients 80 and even 90 years old expect to resume an active lifestyle after their shoulder replacement surgery, so it is important for shoulder surgeons to know the data that are out there, to educate their patients regarding recovery cadence and return to activities, and to try to meet their expectations for activities, including recreational activities, whenever possible.

About the Author

Samer S. Hasan, MD, PhD, is an orthopaedic surgeon specializing in treating shoulder and elbow conditions at Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center (CSMOC) in Cincinnati, Ohio. He is Chief of Orthopaedic Surgery at The Jewish Hospital in Cincinnati, Associate Director of the Cincinnati SportsMedicine Fellowship, and Co-Director of the Cincinnati Shoulder and Elbow Fellowship.

The Tampa Shoulder Course: Arthroplasty & Sports will take place February 1-3, 2024, at the JW Marriott Tampa Water Street and FIVE Labs in Tampa, Florida. Please click here for more information and to register for the course.

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