A randomized single-blinded trial of early rehabilitation versus immobilization after reverse total shoulder arthroplasty

Hagen, Mia S.; Allahabadi, Sachin; Zhang, Alan L.; Grace, Trevor; Benjamin, C.

doi:10.1016/j.jse.2019.10.005

Cited by 43 publications

(81 citation statements)

References 29 publications

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“…The study of Hagen investigated early mobilisation versus 6 weeks of immobilisation and concluded it was safe to start mobilisation early. 16 This study reported similar results between early mobilisation and 6 weeks of immobilisation on the short term and long term. However, the study started mobilisation 1 week postoperative, we start mobilisation directly postoperative.…”

Section: Introductionsupporting

confidence: 76%

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Essen¹,

Kornuijt

Vries³

et al. 2020

BMJ Open

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IntroductionThe use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2–6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes.Methods and analysisIn our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events.Ethics and disseminationThe Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals.Trial registration numberNetherlands Trial Register (NL7656).

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Section: Introductionsupporting

confidence: 76%

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Essen¹,

Kornuijt

Vries³

et al. 2020

BMJ Open

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“…With reference to their primary outcome measure of range of movement (ROM), Denard and Lädermann (2016) reported superior ROM in the early postoperative phase in the immediate rehabilitation group in comparison with the delayed group, but this difference was no longer apparent from 3-month postsurgery. Hagen et al (2020) reported no differences between the early versus immobilised group with reference to their primary outcome measure, the composite American Shoulder and Elbow Score.…”

Section: Discussionmentioning

confidence: 97%

“…In contrast to previously published RCTs, the typical NHS approach to rehabilitation described in this review would be regarded as early or accelerated rather than standard or usual care (Denard & Lädermann, 2016;Hagen et al, 2020). Denard and Lädermann (2016) describe an immediate rehabilitation programme as including 4 weeks of sling immobilisation with passive movement of the shoulder only during this period following anatomic total SA with release and repair of the subscapularis tendon.…”

Section: Discussionmentioning

confidence: 99%

“…Denard and Lädermann (2016) describe an immediate rehabilitation programme as including 4 weeks of sling immobilisation with passive movement of the shoulder only during this period following anatomic total SA with release and repair of the subscapularis tendon. Hagen et al (2020) describe an early rehabilitation programme as including 6 weeks of sling immobilisation with introduction of passive movement seven to 10 days after surgery with gradual progression to active/assisted movement following reverse total SA. With reference to their primary outcome measure of range of movement (ROM), Denard and Lädermann (2016) reported superior ROM in the early postoperative phase in the immediate rehabilitation group in comparison with the delayed group, but this difference was no longer apparent from 3-month postsurgery.…”

Section: Discussionmentioning

confidence: 99%

“…To date, two randomised controlled trials (RCTs) have evaluated different approaches to rehabilitation following SA (Denard & Lädermann, 2016;Hagen et al, 2020). Denard and Lädermann (2016) compared immediate passive motion (sling immobilisation for 4 weeks with immediate introduction of passive shoulder exercise) versus delayed passive motion (sling immobilisation with no shoulder motion for 4 weeks) following anatomic SA.…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information

Littlewood

Morgan

Pitt

et al. 2020

Musculoskeletal Care

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Introduction The prevalence of shoulder arthroplasty (SA) is rising, but there is limited research evaluating rehabilitation following SA and whether there is an optimal approach remains unknown. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following SA as a platform for conducting much needed further research. Methods Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following SA, for example, duration of immobilisation. One reviewer extracted data, and a second reviewer verified this. Ethical approval Not required. Results Forty‐three PIS from 40 Trusts were identified. Twenty‐four referred to more than one type of arthroplasty (anatomic, reverse and hemiarthroplasty) but did not describe different approaches to rehabilitation based on prosthesis type. Twenty‐five PIS provided some instruction regarding movement restrictions, which varied considerably. All PIS referred to postoperative immobilisation, typically with a sling, with median duration of 4 weeks (range 0 to 8). Thirty‐four PIS reported commencing passive exercise immediately. Median time to commencing active exercise was 4 weeks (range 1 to 6) and 5 weeks (range 1 to 16) for resisted exercise. Median time expected to return to driving was 6 weeks (range 3 to 12) and general work 12 weeks (range 3 to 26). Conclusion This study has highlighted significant heterogeneity between rehabilitation approaches following SA, not previously reported in the United Kingdom, with a lack of specific rehabilitation PIS for different prosthesis types. Our results will facilitate evaluation of rehabilitation strategies in future research.

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Fractures Around Shoulder

Dedeoğlu

2022

Fundamentals of the Shoulder

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A randomized single-blinded trial of early rehabilitation versus immobilization after reverse total shoulder arthroplasty

Cited by 43 publications

References 29 publications

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information

Fractures Around Shoulder

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