Return to Weightlifting After Shoulder Arthroplasty: An ASES Multicenter Study Predicting Performance after Reverse Shoulder Arthroplasty (rTSA) and Anatomic Shoulder Arthroplasty (aTSA)

Abstract

Hypothesis and background: Return to sport (RTS) and sport-specific performance following shoulder arthroplasty are not well-characterized, particularly in strength-based activities such as weightlifting. This study evaluates return-to-weightlifting rates, exercise-specific performance, and patient-reported outcomes following reverse shoulder arthroplasty (rTSA) and anatomic shoulder arthroplasty (aTSA).

Methods: We conducted a multicenter analysis of patients from 24 American Shoulder Elbow Society (ASES) surgeons across 17 institutions who underwent rTSA or aTSA and completed sport-specific RTS questionnaires. Study parameters were defined by the Delphi method, requiring 75% agreement for consensus. Data collected included pre- and postoperative participation, timing of return, and patient-reported outcomes on performance, frequency, enjoyment, and satisfaction relative to preoperative status. Specific weightlifting abilities (bench press, bicep curl, overhead press, deltoid raise, and pushups) were assessed. Subgroup analyses included age- and sex-matched comparisons of rTSA and aTSA for glenohumeral osteoarthritis (GHOA), and rTSA for GHOA vs rotator cuff arthropathy (RCA). Statistical analyses included t-tests, chi-square or Fisher's exact test, and multivariable logistic regression. Statistical significance was set at P < 0.05.

Results: Among 175 weightlifters (mean follow-up of 23.3 ± 7.6 months), 93.1% returned to weightlifting and 79.4% reported maintained or improved performance. Most returned by 3-6 months (39.3%), with an additional 29.5% returning by 7-12 months. Propensity-matched analysis of 54 rTSA patients and 54 aTSA patients for GHOA found similar return rates (rTSA: 98.1% vs. aTSA: 96.3%, P > 0.999) and likelihood of improved or maintained performance (rTSA: 90.7% vs. aTSA: 79.6%, P = 0.176). However, rTSA patients were more likely to maintain or increase weightlifting frequency (90.7% vs. 72.2%, P = 0.026) and had higher improvement in deltoid raise ability (82.6% vs. 50.0%, P = 0.020). No significant differences were found in bench press, overhead press, biceps curls, or pushups. Within the rTSA cohort, GHOA patients reported greater postoperative enjoyment (95.6% vs 76.0%, p = 0.021) and percent who improved or maintained frequency (86.7% vs 60.0%, p = 0.025) compared to RCA patients. Multivariate regression found no significant predictors of worse postoperative performance (all P > 0.05).

Conclusion: Most patients resume weightlifting after shoulder arthroplasty, often maintaining or improving performance. Although outcomes are comparable by arthroplasty type, rTSA may afford better deltoid function and increased participation frequency. Additionally, preoperative diagnosis appears to influence enjoyment and engagement following rTSA, despite similar improvements across specific exercises. These findings highlight the complex nature of recovery and the value of personalized preoperative counseling.

Keywords: aTSA; glenohumeral osteoarthritis; multicenter; rTSA; return to sport; rotator cuff arthropathy; shoulder arthroplasty; weightlifting.