Rehabilitation following reverse shoulder arthroplasty

Buchmann, Stefan; Schoch, Christian; Grim, Casper; Jung, Christian; Beitzel, Knut; Klose, Manuel; Mauch, Bettina; Pfalzer, Florian; Tepohl, Lena; Tholen, Reina; Gottfried, Thomas; Ortmann, Hans; Scheibel, Markus; Mauch, Frieder

doi:10.1007/s11678-019-0513-5

Cited by 7 publications

(7 citation statements)

References 51 publications

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“…Besides, after RSA, the stability and mobility of the glenohumeral joint become dependent on the deltoid [28]. As a result, there is a higher requirement for postoperative physiotherapy [10,43], which results in higher costs. Moreover, given the higher rate of multiple complications, and especially when the surgical cost of RSA and length of hospital stay are signi cantly higher, the use of RSA instead of TSA in this group of patients may not be justi ed.…”

Section: Discussionmentioning

confidence: 99%

Total Shoulder Arthroplasty versus Reverse Total Shoulder Arthroplasty: Outcome Comparison in Osteoarthritis patients with or without Concurrent Rotator Cuff Deficiency

Long

Huang

et al. 2021

Preprint

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BackgroundOsteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered.PurposeThis study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good.Study designCross-sectional studyMethodsWe queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis.Results A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups.ConclusionFor OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.

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Section: Discussionmentioning

confidence: 99%

Total Shoulder Arthroplasty versus Reverse Total Shoulder Arthroplasty: Outcome Comparison in Osteoarthritis patients with or without Concurrent Rotator Cuff Deficiency

Long

Huang

et al. 2021

Preprint

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“…(1)(2)(3)(4) However, despite orthopaedic acceptance, significant disagreement exists regarding rTSA rehabilitation guidelines following surgery. (5)(6)(7)(8)(9)(10)(11)(12) Traditionally, postoperative rehabilitation has centered on staged physiotherapy followed by early protective and restrictive joint immobilization.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

“…As a consequence, conservative postoperative rehabilitation orthodoxy has recently been challenged by a select few. (6,7,10,20,21) These outliers adopted an accelerated rehabilitation approach, shortening post-surgical immobilization to a minimum of two weeks rather than the "agreed-upon" expert recommendation of four to six weeks. Coupled with early initiation of range of motion (ROM) training, their protocol sought to optimize and restore shoulder mobility, eliminate postoperative joint capsule adhesions, and scarring between muscle groups; complications commonly associated with prolonged and restricted shoulder immobilization.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

“…Barriers that prevent patients from pushing beyond their limits? To date, we are not aware of any literature describing immediate active shoulder rehabilitation (IASR) training without the utilization of a protective immobilizer, (16,24,25) abduction pillow, (26)(27)(28)(29) sling, (5)(6)(7)9,10,21,(30)(31)(32) or "simple sling" (20,(33)(34)(35)(36)(37)(38) following rTSA. Therefore, the purpose of this randomized controlled pilot study was to evaluate and compare the IASR protocol to current institutional outpatient controls.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

“…This is further illustrated by a recent commission on rehabilitation post rTSA by the German Society of Shoulder and Elbow Surgery (Deutsche Gesellschaft für Schulter-und Ellenbogenchirurgie e. V., DVSE) reporting they were unable to find a single guideline, systematic review, or level 1/2 study in their literature search dating back to1989. (61) Balanced against these dissenting views is the universal orthopaedists' acceptance therapy plays in optimizing patient outcomes, and the absolute need for high-quality prospective research (5,6,10,11,55).…”

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confidence: 99%

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Immediate Accelerated Shoulder Rehabilitation (IASR) vs. Standard Protocol following Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

DeVito

Hatch

Raja

et al. 2020

Preprint

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Background: Recently, the reverse total shoulder arthroplasty (rTSA) became the most frequently performed form of shoulder replacement in the United States and abroad. While physical therapy is universally accepted and routinely practiced, published postoperative rehabilitation guidelines and modifications are based on protocols developed in 1975. Since then, the principle components and temporal concepts of timing and intensity of postoperative rehabilitation and protected immobilization have been controversially applied and expertly discussed without a prevailing consensus. Comparative literature that prospectively addresses treatment differences, influences on outcomes, and superiority or inferiority versus control does not exist. Thus, the objective of this pilot study is to compare an accelerated and immediate active shoulder rehabilitation (IASR) rehabilitation program with standard care in patients following rTSA. Methods:A prospective, randomized, controlled, parallel-designed, two-armed, non-blinded, superiority pilot trial. The comparator arms are an accelerated rehabilitation (IASR) strategy versus standardized care following rTSA (CPT: 23472). The primary outcome measures will be the change from pre-surgical baseline to 52 weeks post-surgery in the American Shoulder and Elbow (ASES) score, Simple Shoulder Test (SST), and global health assessment (PROMIS-10. Secondary and tertiary outcomes will assess subscapularis integrity, implant status, and overall rehabilitation costs compared to formal control. Patients will be recruited from a single site (TRIA Orthopaedic Center, Bloomington, MN) neighboring the fourteenth largest US metropolitan area.Discussion: This trial will be the first study to compare the efficacy and safety of two different postoperative rehabilitation strategies for patients following rTSA. Further, this will be the first study to investigate an accelerated rehabilitation program without a period of protected immobilization following rTSA. Finally, the results will assist in the shared clinical and surgical treatment decisionmaking process.

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