Poster 249. Dominant-Sided Surgery is Associated with Lower Rates of Return to Sport Following Anatomic Total Shoulder Arthroplasty in Active Patients Aged 65 Years and Younger

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Objective: To evaluate whether hand dominance influences return to sport (RTS) after anatomic total shoulder arthroplasty (aTSA) in patients aged 65 years or younger. Methods: Retrospective cohort study of patients <=65 years who underwent primary aTSA for glenohumeral osteoarthritis between 2016 and 2021 in a prospectively maintained institutional registry. Patients were contacted to assess hand dominance, pre- and postoperative sport participation, timing and level of RTS, and satisfaction. Patients with ambidextrous dominance or bilateral surgery were excluded. Participants who played sports preoperatively were grouped by dominant- versus nondominant-sided surgery. Univariate comparisons and sensitivity multivariable logistic regressions were performed; American Shoulder and Elbow Surgeons (ASES) score changes were compared. Results: Of 279 eligible patients, 165 (59.1%) reported preoperative sport participation (dominant-sided aTSA n=95, nondominant n=70) with no baseline differences between groups (all p>0.15, Table 1). Golf (26.1%) was the most commonly reported sport and racquet sports (17.0%) were the second most frequently reported (Table 2). Successful RTS at any level was more common after nondominant-sided aTSA versus dominant-sided aTSA (85.7% vs 69.5%, p=0.015). RTS at the same or higher level was also more frequent after nondominant-sided surgery (61.4% vs 45.3%, p=0.040). Among those who desired to return, nondominant-sided patients had higher RTS (92.3% vs 75.0%, p=0.006). Median time to RTS was similar (219 vs 202 days, p=0.83). Satisfaction trended higher after nondominant-sided surgery ('somewhat' or 'very satisfied' 91.2% vs 80.0%, p=0.051). Improvements in ASES scores at a mean follow-up of 2.8±1.7 years were not significantly different (46.2 [30.5-60.8] for non-dominant vs 37.0 [21.9-59.4] for dominant, p=0.11) (Table 3). Of the 79 patients who failed to RTS at the same level or higher, 'Pain/Discomfort in Shoulder' was the most frequently cited reason for not doing so (32.9%). Sensitivity analyses adjusting for overhead sport, age, sex, BMI, and comorbidity burden yielded consistent results (Table 4). Conclusions: In active patients aged 65 years or younger, nondominant-sided aTSA was associated with significantly higher RTS rates, including return at the same or higher level, with similar functional improvement. Hand dominance may be an important and underrecognized factor to consider in counseling and expectation setting for RTS after aTSA.

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