Monday, February 8, 2016

Will my shoulder be stiff after my shoulder joint replacement?

Factors predicting postoperative range of motion for anatomic total shoulder arthroplasty.

These authors conducted a retrospective review of 230 patients with minimum 1-year follow-up after TSA for end-stage arthropathy with an intact rotator cuff.

They found that preoperative motion in all directions was predictive of postoperative motion for forward flexion (R = 0.235; P < .001), abduction (R = 0.363; P < .001), external rotation (R = 0.325; P < .001), and internal rotation (R = 0.213; P = .002). 

BMI and diabetes both negatively correlated with internal rotation (R = -0.134, P = .40 and R = -0.196, P = .003, respectively). 

Comment: As shown by the graphs below the relationships between pre and postoperative range of motion are significant, but not strong. Less than 15% of the variance in postoperative flexion and less than 7% of the variance in abduction can be explained on the basis of the preoperative ranges.

Post operative range of motion depends on a number of factors in addition to the preoperative range:
the thoroughness of the soft tissue releases,  removal of abutting bone, the size of the arthroplasty components, and the quality of the postoperative rehabilitative program. Some of these factors, including overstuffing, are discussed here. We find it is important to review the patients' expectations and explain the role of their dedication to rehabilitation before proceeding with surgery. At surgery, we find the 40-50-60 rules helpful in optimizing mobility and stability (see here).