Clinical and functional evaluation of patients submitted to reverse arthroplasty with minimum one year of follow-up

Abstract

ObjectiveTo assess the clinical and functional results of patients submitted to reverse arthroplasty with a minimum follow-up of one year.MethodsTwenty-two patients submitted to shoulder reverse arthroplasty by the Surgery and Shoulder Rehabilitation Group were retrospectively evaluated with pre and postoperative imaging analysis, analog pain scale, range of motion, and ASES functional score.ResultsOut of 19 (86.3%) patients with preoperative ASES classified as poor/bad, 11 (57.9%) progress to good/excellent after intervention, showing improvement of function, ranging from a mean preoperative ASES score of 22 (± 18.8) to a postoperative mean of 64.8 (± 27.7) (p = 0.031). Regarding the pain, there was an improvement in analog pain scale, presenting a preoperative mean of 7.64 (1–10) and a postoperative mean of 2.09 (0–7; p < 0.001). Regarding mobility, of 22 patients, 15 (68.2%) had preoperative pseudoparalysis and, of these, ten (66.7%) had an active anterior elevation greater than 90° after reverse arthroplasty. In turn, patients without pseudoparalysis had no significant gain in range of motion (p = 0.002). The authors observed active anterior elevation gain, with a preoperative mean of 76° (0–160°) and a postoperative mean of 111° (0–160°; p = 0.002).ConclusionDespite being a relatively new procedure in Brazil, reverse shoulder arthroplasty can be used effectively and safely in patients who were previously without treatment options such as rotator cuff arthropathy and revisions providing pain relief, improvement of function, and mobility of the upper limb.

Clinical and Functional Results of Reverse Total Shoulder Arthroplasty and Postoperative Rehabilitation Protocol

“…These results are in agreement with the existing literature, which shows an improvement in pain, as well as a progression of flexion and abduction mobility after RTSA, due to the increase of the lever arm and consequent optimization of deltoid muscle function [12]. However, the literature is inconsistent concerning the postoperative improvement of external rotation motion [9,[15][16]. The authors consider that this difference may be due to the type of prosthesis and surgical technique used, to the absence of an isolated evaluation of external rotation movement in the CS, but especially to the preoperative state of these muscles.…”

“…In addition, lateralized prostheses appear to provide a more sustained improvement in external rotational range of motion compared to medialized prostheses [18,21]. In order to obtain better clinical and functional results in terms of external rotation, new surgical techniques are being performed, namely, the latissimus dorsi and teres major tendon transfers [9,11,22]. Patients undergoing this procedure have experienced an improvement in pain and functionality, but a higher rate of complications may be associated.…”

“…These changes facilitate shoulder elevation movement, with greater amplitude until a subacromial conflict occurs [2]. Several factors influence the functional results of RTSA, such as surgical indication, surgeon's experience, surgical technique, patient characteristics, and postoperative rehabilitation [9].…”