Return to work after shoulder arthroplasty: a systematic review and meta-analysis

Abstract

Background: With the rising incidence of shoulder arthroplasty, there is increasing emphasis on improving functional outcomes and ability to return to work (RTW). The purpose of this study was to determine the rate of RTW after shoulder arthroplasty.

Methods: This systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of 4 electronic databases was performed from database conception through April 2018 to identify studies reporting data on RTW after shoulder arthroplasty. The primary outcome was the rate of RTW after shoulder arthroplasty. Random-effects meta-analysis was used to pool the rate of RTW across studies.

Results: Seven studies were reviewed, including 447 patients at an average follow-up of 4.4 years (range, 1.0-12.6 years). The overall rate of RTW was 63.6% (95% confidence interval, 58.8%-68.2%) at a mean 2.3 months postoperatively (range, 0.3-24.0 months). RTW was significantly lower for patients with heavy-intensity occupations vs. all intensity types (61.7% vs. 67.6%; P = .04). RTW did not differ between anatomic total shoulder arthroplasty (63.4%) and hemiarthroplasty (66.1%) or reverse total shoulder arthroplasty (61.5%; P = .53). There were no significant differences in RTW among underlying diagnoses (osteoarthritis, 64.4%; cuff tear arthropathy, 65.6%; proximal humerus fracture, 69.1%; P = .41) or by workers' compensation status (61.2% vs. 65.3%; P = .41).

Conclusions: A majority of patients return to work after shoulder arthroplasty at an average of 2.3 months postoperatively. Those with heavy-intensity occupation return at significantly lower rates, whereas no differences in RTW by arthroplasty type, underlying diagnosis, or workers' compensation were found.

Keywords: Return to work; meta-analysis; reverse total shoulder arthroplasty; shoulder arthroplasty; shoulder hemiarthroplasty; total shoulder replacement.