Dominant-Sided Surgery Is Associated With Lower Rates of Return to Sport After Anatomic Total Shoulder Arthroplasty in Active Patients Aged 65 Years and Younger

Abstract

Background:

Anatomic total shoulder arthroplasty (aTSA) has demonstrated excellent outcomes for pain relief, functional restoration, and implant survival in patients with glenohumeral osteoarthritis. While return to sport (RTS) has become an increasingly important measure of surgical success in this population, the role of hand dominance in this context remains poorly understood.

Purpose:

To evaluate the impact of hand dominance on RTS after aTSA in patients aged ≤65 years.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients aged ≤65 years who underwent primary aTSA for glenohumeral osteoarthritis between 2016 and 2021 were identified using a prospectively maintained institutional registry. All patients were contacted to assess hand dominance, pre- and postoperative sport participation, timing and level of RTS, and satisfaction. Patients were categorized by whether surgery was performed on the dominant or nondominant shoulder. Patients with ambidextrous hand dominance or bilateral surgery were excluded. Univariate and multivariable comparisons were performed.

Results:

Of 279 eligible patients, 165 (59.1%) reported preoperative sport participation, of which 57.6% (n = 95) underwent dominant-sided aTSA and 42.4% (n = 70) underwent nondominant-sided aTSA. There were no significant differences in baseline characteristics between groups (P > .15 for all). Successful RTS at any level was significantly more common in the nondominant group versus the dominant group (85.7% vs 69.5%; P = .015). Similarly, RTS at the same or higher level of sport was significantly more common in the nondominant versus dominant group (61.4% vs 45.3%; P = .040). American Shoulder and Elbow Surgeons score improvements at a mean follow-up of 2.8 years (SD, 1.7) were not significantly different between the nondominant- and dominant-sided groups (median [IQR], 46.2 [30.5-60.8] vs 37.0 [21.9-59.4]; P = .11).

Conclusion:

In patients aged ≤65 years, aTSA on the nondominant shoulder was associated with a significantly higher rate of RTS. These findings suggest that hand dominance may be an important and underrecognized factor in RTS outcomes after aTSA in young, active patients.