Mia S Hagen1, Sachin Allahabadi1, Alan L Zhang1, Brian T Feeley1, Trevor Grace1, C Benjamin Ma2. 1. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA. 2. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: MaBen@orthosurg.ucsf.edu.
Abstract
BACKGROUND: Reverse total shoulder arthroplasty (RTSA) does not have a standard postoperative protocol. Although instability is a worrisome complication, prolonged immobilization may also be disabling in the elderly population. This study aimed to determine if early vs. delayed range of motion (ROM) after RTSA affected postoperative ROM, patient-reported outcomes, and the dislocation rate. METHODS: A single-blinded, randomized controlled trial was performed enrolling patients from 2013 to 2017. Patients were randomly assigned to either a delayed-rehabilitation group (no ROM for 6 weeks) or early-rehabilitation group (immediate physical therapy for passive and active ROM) and followed up for a minimum of 1 year. Demographic characteristics, ROM, American Shoulder and Elbow Surgeons (ASES) scores, and complications were recorded. RESULTS: Of an initial enrollment of 107 shoulders, 80.3% completed 1-year follow-up: 44 shoulders in the delayed-therapy group and 42 shoulders in the immediate-therapy group. Both groups had significantly improved forward flexion (32° improvement) and abduction (22° improvement) by 3 months. Both groups showed significant improvements in ASES scores by 6 weeks (9.4-point improvement in composite score) with continued improvement through 6 months (35.1 points). No significant differences were found between groups for any postoperative measure, with the exception of the ASES functional score favoring the delayed-therapy group at 6 months (26.3-point improvement vs. 16.7-point improvement). No differences in complications, notching, or narcotic use were noted between groups. CONCLUSIONS: Both early- and delayed-ROM protocols after RTSA demonstrated significant, similar improvements in ROM and outcomes. Early initiation of postoperative rehabilitation may benefit the elderly population by avoiding the limitations of prolonged immobilization postoperatively.
RCT Entities:
BACKGROUND: Reverse total shoulder arthroplasty (RTSA) does not have a standard postoperative protocol. Although instability is a worrisome complication, prolonged immobilization may also be disabling in the elderly population. This study aimed to determine if early vs. delayed range of motion (ROM) after RTSA affected postoperative ROM, patient-reported outcomes, and the dislocation rate. METHODS: A single-blinded, randomized controlled trial was performed enrolling patients from 2013 to 2017. Patients were randomly assigned to either a delayed-rehabilitation group (no ROM for 6 weeks) or early-rehabilitation group (immediate physical therapy for passive and active ROM) and followed up for a minimum of 1 year. Demographic characteristics, ROM, American Shoulder and Elbow Surgeons (ASES) scores, and complications were recorded. RESULTS: Of an initial enrollment of 107 shoulders, 80.3% completed 1-year follow-up: 44 shoulders in the delayed-therapy group and 42 shoulders in the immediate-therapy group. Both groups had significantly improved forward flexion (32° improvement) and abduction (22° improvement) by 3 months. Both groups showed significant improvements in ASES scores by 6 weeks (9.4-point improvement in composite score) with continued improvement through 6 months (35.1 points). No significant differences were found between groups for any postoperative measure, with the exception of the ASES functional score favoring the delayed-therapy group at 6 months (26.3-point improvement vs. 16.7-point improvement). No differences in complications, notching, or narcotic use were noted between groups. CONCLUSIONS: Both early- and delayed-ROM protocols after RTSA demonstrated significant, similar improvements in ROM and outcomes. Early initiation of postoperative rehabilitation may benefit the elderly population by avoiding the limitations of prolonged immobilization postoperatively.
Authors: Helen Razmjou; Varda van Osnabrugge; Mark Anunciacion; Andrea Nunn; Darren Drosdowech; Ania Roszkowski; Analia Szafirowicz; Dragana Boljanovic; Amy Wainwright; Diane Nam Journal: J Shoulder Elb Arthroplast Date: 2021-07-01
Authors: June S Kennedy; Emily K Reinke; Lisa G M Friedman; Chad Cook; Brian Forsythe; Robert Gillespie; Armodios Hatzidakis; Andrew Jawa; Peter Johnston; Sameer Nagda; Gregory Nicholson; Benjamin Sears; Brent Wiesel; Grant E Garrigues; Christopher Hagen; Insup Hong; Marcella Roach; Natasha Jones; Kuhan Mahendraraj; Evan Michaelson; Jackie Bader; Libby Mauter; Sunita Mengers; Nellie Renko; John Strony; Paul Hart; Elle Steele; Amanda Naylor; Jaina Gaudette; Katherine Sprengel Journal: Arch Physiother Date: 2021-12-10
Authors: Tom van Essen; Anke Kornuijt; Lieke Maria Anna de Vries; Remco Stokman; Walter van der Weegen; Rob Bogie; Robert Jan Hillen; D A van Kampen Journal: BMJ Open Date: 2020-08-20 Impact factor: 2.692
Authors: Maria Moffatt; Gareth Whelan; Peter Gill; Bruno Mazuquin; Peter Edwards; Chris Peach; Ronnie Davies; Marie Morgan; Chris Littlewood Journal: Clin Rehabil Date: 2021-11-01 Impact factor: 3.477