Paper 25: Patients return to sport at similar rates following reverse and anatomic total shoulder arthroplasty: a matched cohort study in active patients younger than 65 years

Objectives: To compare return to sport (RTS), time to RTS, satisfaction, and American Shoulder and Elbow Surgeons (ASES) outcomes between anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in patients aged 65 years or younger.
Methods: Retrospective matched cohort (Level III) using a prospectively maintained institutional registry of primary glenohumeral osteoarthritis (2016-2021). rTSA patients were matched 1:2 to aTSA by age, sex, body mass index, and Charlson Comorbidity Index. Pre- and postoperative sport participation, timing and level of RTS, reasons for non-return, and satisfaction were collected with a standardized survey; ASES scores were obtained from the registry. Exclusions included rotator cuff tear arthropathy and revision procedures. Group comparisons used t-tests and chi-square analyses.
Results: A total of 150 patients were included after matching (100 aTSA, 50 rTSA) with no significant baseline differences (Table 1). Golf was the most frequently reported sport at 41.0% for aTSA and 42.9% for rTSA. RTS at any level occurred in 76.9% of aTSA and 85.7% of rTSA patients (p=0.42), while RTS at the same or higher level occurred in 46.2% for aTSA vs 57.1% for rTSA (p=0.42). Median time to RTS was 176 days for aTSA and 154 days for rTSA (p=0.57). Satisfaction was high and similar (91.0% for aTSA vs 86.0% for rTSA, p=0.35). Preoperative ASES scores did not differ (41.0+-19.1 for aTSA vs 37.2+-18.5 for rTSA, p=0.25), and mean improvement at final follow-up was comparable (45.2+-21.7 for aTSA vs 41.9+-25.6 for rTSA, p=0.50) (Table 2).
Conclusions: In active patients <=65 years with primary glenohumeral osteoarthritis, rTSA and aTSA yielded comparable RTS rates, time to return, satisfaction, and functional improvement. These findings support rTSA as a viable option for select younger patients when appropriately indicated; prospective sport-specific studies with longer follow-up are warranted.