Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2022; 13(9): 837-852
Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.837
Return to work following shoulder arthroplasty: A systematic review
Simon P Lalehzarian, Avinesh Agarwalla, Joseph N Liu
Simon P Lalehzarian, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
Avinesh Agarwalla, Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
Joseph N Liu, USC Epstein Family Center for Sports Medicine, Keck Medicine for USC, Los Angeles, CA 90033, United States
Author contributions: All authors made significant contributions toward the preparation of this manuscript. Lalehzarian SP wrote the article, critically revised the article, and participated in the final approval of the version to be published; Agarwalla A critically revised the article and participated in the final approval of the version to be published; Liu JN designed the work, critically revised the article, and was responsible for final approval of the version to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph N Liu, MD, Assistant Professor, USC Epstein Family Center for Sports Medicine, Keck Medicine for USC, 1520 San Pablo St #2000, Los Angeles, CA 90033, United States. joseph.liu@med.usc.edu
Received: February 1, 2022
Peer-review started: February 1, 2022
First decision: May 31, 2022
Revised: June 13, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: September 18, 2022
Processing time: 227 Days and 11.5 Hours
Abstract
BACKGROUND

Many patients prioritize the ability to return to work (RTW) after shoulder replacement surgeries such as total shoulder arthroplasty (TSA), reverse TSA (rTSA), and shoulder hemiarthroplasty (HA). Due to satisfactory clinical and functional long-term outcomes, the number of shoulder replacements performed will continue to rise into this next decade. With younger individuals who compose a significant amount of the workforce receiving shoulder replacements, patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.

AIM

To summarize RTW outcomes following TSA, rTSA, and HA, and analyze the effects of workers’ compensation status on RTW rates and ability.

METHODS

This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search regarding RTW following shoulder arthroplasty was performed using four databases (PubMed, Scopus, Embase, and Cochrane Library), and the Reference Citation Analysis (https://www.referencecitationanalysis.com/). All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included. Nonclinical studies, literature reviews, case reports, and those not reporting on RTW after shoulder arthroplasty were excluded.

RESULTS

The majority of patients undergoing TSA, rTSA, or HA were able to RTW between one to four months, depending on work demand stratification. While sedentary or light demand jobs generally have higher rates of RTW, moderate or heavy demand jobs tend to have poorer rates of return. The rates of RTW following TSA (71%-93%) were consistently higher than those reported for HA (69%-82%) and rTSA (56%-65%). Furthermore, workers’ compensation status negatively influenced clinical outcomes following shoulder arthroplasty. Through a pooled means analysis, we proposed guidelines for the average time to RTW after TSA, rTSA, and HA. For TSA, rTSA, and HA, the average time to RTW regardless of work demand stratification was 1.93 ± 3.74 mo, 2.3 ± 2.4 mo, and 2.29 ± 3.66 mo, respectively.

CONCLUSION

The majority of patients are able to RTW following shoulder arthroplasty. Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.

Keywords: Shoulder replacement, Total shoulder arthroplasty, Reverse total shoulder arthroplasty, Hemiarthroplasty, Return to work

Core Tip: Many patients prioritize the ability to return to work after shoulder replacement surgeries such as total shoulder arthroplasty, reverse total shoulder arthroplasty, and shoulder hemiarthroplasty. While rates of return to work have been studied in the literature following shoulder arthroplasty, a consensus on which is the most effective treatment is still controversial. Information about the ability to return to work following any type of shoulder arthroplasty would assist patients and surgeons in managing expectations and put into place evidence-based guidelines. This systematic review examines how return to work following shoulder arthroplasty has been studied and reported in the literature.