Michael Fu, MD
Journal Club is a recurring series where we highlight the latest orthopedic shoulder research, and discuss potential applications and ramifications for our patients.
Title
Return to golf and golf-specific performance after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty
Authors
Drew A. Lansdown, MD, Edward C. Cheung, MD, Mya S. Aung, BS, Alan L. Zhang, MD, Brian T. Feeley, MD, C. Benjamin Ma, MD
Journal
Seminars in Arthroplasty: Journal of Shoulder and Elbow Surgery. 2021 February 8.
Abstract
Background
Golf is a common sporting activity that patients continue to participate into older age, including after joint replacement surgery. The influence of shoulder replacement on golf performance remains unclear. We hypothesized that patients undergoing anatomic total shoulder arthroplasty (TSA) would have significantly better return to play rates and better performance metrics, including handicap, driving distance, and 7-iron distance, after shoulder replacement relative to those treated with reverse total shoulder arthroplasty (RTSA).
Methods
Patients were retrospectively surveyed after anatomic TSA and RTSA with regards to return to golf and golf performance before and after shoulder replacement. Patients reported if they were able to return to golf after shoulder replacement, timing of return to golf, and driving distance, 7-iron distance, handicap, and difficulty with specific shot types upon returning to golf. Significance was defined as P < .05.
Results
The survey was completed by 31 patients with a total of 37 replaced shoulders (68.0 ± 8.1 years; 87% male) out of 44 patients who indicated they played golf. The overall return to golf rate was 74%. Patients undergoing anatomic TSA returned at a significantly higher rate relative to patients treated with RTSA (93% [14 of 15] vs. 56% [9 of 16], P= .037). There was no difference between groups with regards to drive distance, 7-iron distance, and handicap. There were also no differences between preoperative and postoperative values for patients who were able to return to golf. Overall, patients played golf less frequently afterward than they did prior to shoulder replacement (P= .013).
Conclusion
Patients are able to return to golf after shoulder replacement, at an overall rate of 74%, including a rate of 93% for patients with anatomic TSA and 56% for patients with RTSA. Golf performance was similar before and after shoulder replacement surgery for both groups among those who were able to return to play, though overall frequency was decreased after shoulder replacement.
Level of evidence
Level III; Retrospective comparative study.
Keywords
Shoulder replacement; Return to golf; Reverse shoulder arthroplasty; Anatomic total shoulder arthroplasty; Golf performance
Discussion - Return to Golf after Total Shoulder Replacement
As shoulder replacement becomes increasingly popular and the technology continues to evolve, patient outcomes and post-surgical expectations continue to improve as well. While total shoulder replacement is quite reliable at relieving pain and restoring function with activities of daily living, patients often want and expect to return to sports. Among patients considering shoulder replacement, the most common sports include golf, tennis, and swimming, among others.
In this study by Dr. Lansdown and colleagues at UCSF, the authors surveyed 31 golf players that underwent total shoulder replacement, both anatomic and reverse replacement. The patients were mostly men (87%), with an average age of 68 years. The authors found that patients that had anatomic shoulder replacement returned to golf at a significantly higher rate (93%) than patients that had reverse shoulder replacement (56%). Among the patients that were able to return to golf, however, there was no difference in drive distance, 7-iron distance, and handicap between the anatomic and reverse shoulder replacement patients.
This discrepancy in return to golf rates between anatomic and reverse shoulder replacement is consistent with my clinical experience as well. Compared to the reverse, anatomic shoulder replacement typically provides greater range of motion after surgery, however, the rotator cuff must be intact for an anatomic shoulder replacement to work well. This is because the anatomic shoulder replacement, as the name indicates, recreates the normal anatomy of the shoulder. For patients with rotator cuff issues in conjunction with shoulder arthritis, or rotator cuff tear arthropathy, reverse shoulder replacement is usually the better option because it does not require a rotator cuff to work. The reverse shoulder replacement is able to function in the absence of a rotator cuff because it is a more constrained prosthesis - there is more congruency between the ball and the socket, and the socket is also much deeper. Unfortunately, the trade-off for this increased stability and constraint is reduced range of motion. This likely contributes to the lower rate of return to sports after reverse shoulder replacement relative to anatomic shoulder replacement.
While the total arc of motion will be less after reverse compared to anatomic shoulder replacement, the position of that arc of motion can be influenced by surgical positioning of the implants. This is where my colleagues and I at the Hospital for Special Surgery are devoting much of our research efforts. Every patient is unique in terms of their anatomy, activities, and expectations. The ultimate goal is to perform shoulder replacement operations that are tailored to each individual patient through understanding each patient’s post-surgical goals, and patient-specific surgical planning. For example, for a patient planning to undergo reverse total shoulder replacement and wants to return to golf, we could load her CT scan into surgical planning software, create a render of her unique anatomy, consider whether this is her lead shoulder or her trail shoulder in the golf swing, and plan her surgery in such a way as to maximize the range of motion that would hopefully allow her to return to golf.
Patient-specific surgical planning for reverse total shoulder replacement, with range of motion optimization.
About the Author
Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.
Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.