Systematic Reviews
Copyright ©The Author(s) 2022.
World J Orthop. Sep 18, 2022; 13(9): 837-852
Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.837
Table 1 Study characteristics
Ref.
Design
No. of groups
Level of evidence
Mean follow-up (range), yr
MINORS score
Bülhoff et al[10], 2015Retrospective1IV6.2 (2.6-12.6)7/16
Jawa et al[56], 2015Retrospective2III3.9 (2.0-5.6)17/24
Morris et al[55], 2015Retrospective2III3.5 (2-8)20/24
Garcia et al[28], 2016Retrospective1IV2.6 (1-4.7)10/16
Garcia et al[36], 2016Retrospective1IV5.1 (1-7.5)10/16
Hurwit et al[11], 2017Retrospective2IIIHHA: 5.3 (1.1-7.5); rTSA1: 2.7 (1.0-4.9)16/24
Liu et al[12], 2018Retrospective1IV5.4 (2.5-8.6)10/16
Kurowicki et al[41], 2018Retrospective2III2.4 (0.5-7.6)17/24
Gowd et al[48], 2019Retrospective2IIIHemi RR: 5.7 (SD ± 2.0); aTSA: 5.8 (SD ± 2.2)17/24
Cvetanovich et al[21], 2020Retrospective1IV3.4 (1.9-5.0)9/16
Jayasekara et al[22], 20202Retrospective3IVNRNA
Liu et al[49], 2020Retrospective2IIIHHA: 5.2 (2.0-7.5); aTSA: 5.18 (2.0-7.49)16/24
1Represents duplicate data from Garcia et al[28]; not included in meta-analysis.
2Numbers are relevant to groups who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty.
MINORS: Methodological Index for Non-Randomized Studies; HHA: Humeral hemiarthroplasty; rTSA: Reverse total shoulder arthroplasty; NR: Not reported; NA: Not available; Hemi RR: Hemiarthroplasty with ream-and-run resurfacing; aTSA: Anatomic total shoulder arthroplasty.
Table 2 Characteristics of the patients
Ref.
No. of shoulders
Mean age (range), yr
Gender (M/F), n
Dominant/nondominant, n
BMI, kg/m2 (range)
WC/NWC
RTW (%)
Work intensity
Bülhoff et al[10], 201515472 (33-88)35/119103/51NRNR22/57 (38.6)1NR
Jawa et al[56], 20151355.9 (39-74)13/0NRNR13/04/13 (30.8)1 light, 12 heavy
Morris et al[55], 201528WC: 58.8 (49-69); NWC: 63.4 (50-72)20/819/9WC: 32.0 (SD ± 8.4); NWC: 27.1 (SD ± 5.3)14/14WC: 2/14 (14.3); NWC: 5/11 (45.5)1WC: 8 sedentary/light, 6 heavy/strenuous; NWC: 3 retired, 7 sedentary/light, 4 heavy/strenuous
Garcia et al[28], 2016 (rTSA)4074.7 (56-82)16/2426/1428.8 (14.8-46.2)0/4026/40 (65)25 sedentary, 15 light
Garcia et al[36], 2016 (HHA)7969 (27.6-97.1)24/5562/1728.3 (19.8-49.3)0/7934/49 (69.4)120 sedentary, 25 light, 4 moderate
Hurwit et al[11], 201781HHA: 60.8 (40-88); rTSA: 68.6 (41-48)33/4852/29HHA: 28.9; rTSA: 29.5NR55/81 (84.6)44 sedentary, 33 light, 4 heavy
Liu et al[12], 20185267.2 (56-96)38/1424/2828.0 (18.1-52.9)5/4748/52 (92)10 sedentary, 14 light, 17 moderate, 11 heavy
Kurowicki et al[41], 20182265aTSA: 69; rTSA: 75NRNRNRNR21% higher difference in ability to RTW following aTSA than rTSA115 retired, 72 housework, 49 desk job, 16 prolonged standing, 11 yard work, 9 creative jobs, 5 requires lifting, 4 carpenter/construction, 5 cook/food prep
Gowd et al[48], 201953Hemi RR: 52.8 ± 7.7; aTSA: 53.3 ± 9.248/528/25Hemi RR: 28.5 ± 3.5; aTSA: 31.1 ± 5.74/4950/53 (94.3)17 sedentary, 12 light, 13 moderate, 11 heavy
Cvetanovich et al[21], 20202752.1 ± 6 (42-63)25/2NRNR3/2425/27 (92.6)5 sedentary, 2 light, 9 moderate, 11 heavy
Jayasekara et al[22], 2020383TSA: 65 ± 1.6 (48-86); rTSA: 72 ± 1.6 (54-91); Hemi: 72 ± 2.7 (57-84)42/41NRNR3/8355/83 (66.3)28 full duty, 27 lighter duty
Liu et al[49], 202049HHA: 62.4 (42.7-87.7); aTSA: 61.7 (47.7-75.6)22/2730/19HHA: 29.8 ± 7.1; aTSA: 29.2 ± 6.5NR36/49 (73.5)20 sedentary, 21 light, 6 heavy
1Excluding those who were retired preoperatively, retired due to medical concerns, or retired due to non-specified reasons.
2Only includes individuals who responded to question 10 of the ASES questionnaire in regards to work.
3Numbers are relevant to groups who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty.
M: Male; F: Female; BMI: Body mass index; WC: Workers' compensation; NWC: Non-workers' compensation; RTW: Return to work; NR: Not reported; aTSA: Anatomic total shoulder arthroplasty; rTSA: Reverse total shoulder arthroplasty; HHA: Humeral hemiarthroplasty.
Table 3 Diagnosis and surgical characteristics
Ref.
Diagnosis
Surgery
Mean time out of work (range), mo
Complications
Bülhoff et al[10], 2015Primary OA, 154 (100%)aTSANRNR
Jawa et al[56], 2015OA, 11 (84.6%); capsulorrhaphy arthropathy, 2 (15.4%)aTSA4.2 (2.9-6.0)NR
Morris et al[55], 2015CTA, 14; massive RCT, 8; post-traumatic malunion, 4; failed prior arthroplasty, 2rTSANRWC (4): postoperative anterior dislocation (2), intraoperative humeral shaft fracture, postoperative periprosthetic infection; NWC (2): postoperative anterior dislocation
Garcia et al[28], 2016 (rTSA)CTA, 21 (53.5%); OA, 10 (25%); PHFx, 7 (17.5%); RA, 2 (5%)rTSA2.3 (0.5-11)NR
Garcia et al[36], 2016 (HHA)OA, 40 (50.6%); PHFx, 17 (21.5%); AVN, 11 (13.9%); CTA, 8 (10.1%); RA, 3 (3.8%)HHA1.4 (0.25-24)8 complications: 4 revision HHA (2 for dislocation, 2 for periprosthetic fracture after fall); 3 HHA revised to TSA; 1 HHA revised to rTSA for continued pain/glenoid wear
Hurwit et al[11], 2017CTA, 63 (77.8%); RA, 14 (17.2%); PHFx, 2 (2.5%)rTSA; HHArTSA: 3.1; HHA: 2.3rTSA: 20 chronic pain and stiffness/limited mobility; 1 returned to OR; HHA: 4 chronic pain and stiffness/limited mobility; 5 returned to OR
Liu et al[12], 2018OA, 42 (81%); failed prior arthroplasty, 7 (13%); AVN, 2 (4%); RA, 1 (2%)aTSA2.1 (SD: 1.7)22 complications: 17 postoperative stiffness, 6 chronic pain, 3 instability, 4 returned to OR
Kurowicki et al[41], 2018NRaTSA; rTSANRNR
Gowd et al[48], 2019End-stage glenohumeral OA, 53 (100%)Hemi RR; aTSAHemi RR: 2.5 ± 4.8; aTSA: 1.98 ± 2.6Hemi RR: 3 chronic pain, 1 felt unstable, 5 postoperative stiffness, 1 nagging soreness, 1 acute pain, 2 conversion to aTSA, 1 received arthroscopic debridement; aTSA: 1 chronic pain, 2 weakness, 6 postoperative stiffness, 1 subscapularis repair, 1 revision with glenoid explantation due to loosening
Cvetanovich et al[21], 2020Glenohumeral OA, 23 (85.1%); post-traumatic OA, 4 (14.9%)aTSA3.7 ± 5.21 hematoma, 1 pulmonary embolism
Jayasekara et al[22], 20201NRaTSA; rTSA; HHANRNR
Liu et al[49], 2020End-stage glenohumeral OA, 49 (100%)HHA; aTSAHHA: 1.9 ± 2.3; aTSA: 1.3 ± 1.0HHA: 15 chronic pain, 8 postoperative stiffness, 2 conversion to aTSA, 2 conversion to rTSA; aTSA: 3 postoperative stiffness
1Numbers are relevant to groups who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty.
OA: Osteoarthritis; CTA: Cuff tear arthropathy; RCT: Rotator cuff tear; PHFx: Proximal humerus fracture; RA: Rheumatoid arthritis; AVN: Avascular necrosis; aTSA: Anatomic total shoulder arthroplasty; rTSA: Reverse total shoulder arthroplasty; HHA: Humeral hemiarthroplasty; TSA: Total shoulder arthroplasty; NR: Not reported; WC: Workers' compensation; NWC: Non-workers compensation; OR: Operating room.
Table 4 Return to work after total shoulder arthroplasty vs hemiarthroplasty[49]
Occupation intensity
RTW after TSA (%)
RTW after HA (%)
Sedentary7/7 (100)8/13 (62)
Light9/11 (82)7/10 (70)
Heavy3/3 (100)1/3 (33)
Total20/23 (87)16/26 (62)
RTW: Return to work; TSA: Total shoulder arthroplasty; HA: Hemiarthroplasty.
Table 5 Return to work after hemiarthroplasty vs reverse total shoulder arthroplasty[11]
Occupation intensity
RTW after HA (%)
RTW after rTSA (%)
Sedentary14/19 (74)17/25 (68)
Light13/18 (72)9/15 (60)
Heavy12/4 (50)-
Total29/41 (71)26/40 (65)
1No reverse total shoulder arthroplasty patients were classified into the heavy work category.
RTW: Return to work; rTSA: Reverse total shoulder arthroplasty; HA: Hemiarthroplasty.
Table 6 Time to return to work (mo)
Intensity1
Sedentary
Light
Moderate
Heavy
Overall
TSA
Gowd et al[48], 20192.1 ± 3.81.3 ± 1.22.1 ± 2.03.0 ± 2.82.0 ± 2.6
Liu et al[12], 20181.3 ± 1.21.6 ± 1.32 ± 1.74.2 ± 2.02.1 ± 1.7
Liu et al[49], 20201.04 ± 0.871.06 ± 0.73-1.83 ± 1.041.29 ± 0.96
Cvetanovich et al[21], 2020----3.7 ± 5.2
Average21.19 ± 1.241.25 ± 0.992.03 ± 1.792.96 ± 3.231.93 ± 3.74
rTSA
Garcia et al[28], 2016/ Hurwit et al[11], 201731.38 ± 0.934 ± 3.4--2.3 ± 2.4
HA
Hurwit et al[11], 2017/Garcia et al[24], 201541.96 ± 3.02.72 ± 2.6-13.13 ± 15.43.1 ± 4.9
Gowd et al[48], 20190.9 ± 1.11.0 ± 1.76.8 ± 11.53.1 ± 2.32.5 ± 4.8
Liu et al[49], 20201.06 ± 0.982.76 ± 3.27-2.2551.88 ± 2.34
Average21.09 ± 1.362.00 ± 3.366.8 ± 11.53.16 ± 2.742.29 ± 3.66
1Intensity as based on US Department of Labor[56].
2Pooled means using meta analysis[57].
3Both studies used the same reverse total shoulder arthroplasty population.
4Both studies used the same hemiarthroplasty population.
5Only one patient in the heavy group, so no standard deviation available.
TSA: Total shoulder arthroplasty; rTSA: Reverse total shoulder arthroplasty; HA: Hemiarthroplasty.