Why do patients not return to sports or work after anatomical or reverse total shoulder arthroplasty? A systematic review and meta-analysis.

Background: Several studies have been published regarding the rate of return to sports or work after shoulder arthroplasty. However, there are no systematic reviews regarding the reasons for not returning to sports or work. The aim of this study is to assess the rate of return to sports or work and the reasons not to return to sports or work in patients undergoing total shoulder arthroplasty. Methods: The search was performed on the 23rd of April 2024 in multiple databases. Studies reporting return to work or return to sport after anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) with a minimum follow-up of 2 years and studies reporting the reasons for no return to sport or no return to work after anatomical or reverse shoulder arthroplasty were included. Results: Our search resulted in 393 articles, of which 31 studies were included. In total, 18 studies reported the reasons for not returning, whereas 13 did not. The mean (95% confidence interval) return rate to sport was 91% (86%-95%) after aTSA and 80% (72%-89%) after rTSA. Reasons not to return to sport were shoulder related in 13 of the 27 cases after aTSA and in 6 of the 19 cases after rTSA. The mean (95% confidence interval) return rate to work was 76% (59%-93%) after aTSA and 46% (26%-66%) after rTSA. Reasons not to return to work were shoulder related in 4 of the 15 cases after aTSA and in 8 of the 35 cases after rTSA. Conclusion: A high return to sport can be expected after total shoulder arthroplasty. The rate of return to work after aTSA is high; this is in contrast to patients with an rTSA who are less likely to return to work. Interestingly, most reasons not to return to sport or work after shoulder arthroplasty are not shoulder related. Reporting of reasons not to return to sport or work is limited; this should be considered in future studies.