Does upper limb dominance influence outcomes in adults undergoing primary anatomic or reverse total shoulder arthroplasty? A systematic review.

Background: While several patient-specific factors have been shown to influence anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) outcomes, the effect of operated limb dominance remains unclear. Therefore, we performed a systematic review to examine the effect of upper limb dominance on post-operative outcomes. Methods: We queried PubMed, Embase, and Cochrane to identify relevant level IV or greater studies on adults. Risk-of-bias was assessed with Risk Of Bias In Non-Randomized Studies of Exposure. Results were qualitatively synthesized by outcome. Results: Thirty studies (7,916 shoulders, 7,897 patients) were included. Two out of 4 studies demonstrated greater forward elevation and internal rotation on the dominant arm after aTSA. No association between arm dominance and post-operative patient-reported outcome measures was identified in 14 studies. Adverse rTSA outcomes on the dominant side were more likely to be associated with greater dissatisfaction and loss of independence in 3 studies. One out of 3 studies showed greater incidence of radiolucent lines in dominant-side implants at 10-year follow-up. Some studies indicated a higher risk of acromial stress fractures for dominant limb rTSAs, while studies had conflicting results regarding subacromial notching. There was no difference in revision rates in 4 studies. Conclusion: In this systematic review, dominant arm surgery, particularly after aTSA, may facilitate earlier functional recovery but could also be associated with long-term radiographic changes. Nevertheless, arm dominance does not appear to influence patient-perceived clinically meaningful improvement. A potential association with early acromial stress fracture after rTSA was also observed. These findings may inform patient counseling and serve as a basis for future research.