These authors point out that the ideal rehabilitation program after a reverse total shoulder arthroplasty (RTSA) has not been established.
They conducted a single-blinded, randomized controlled trial was performed enrolling patients from 2013 to 2017. Patients were randomly assigned at their 1-week follow-up to 1 of 2 groups: (1) delayed rehabilitation (sling immobilization with no passive or active motion of the shoulder for 6 weeks) or (2) immediate rehabilitation (immediate physical therapy for passive and active ROM and weaning of sling use as tolerated but no resistance training for 6 weeks).
86% of these patients had their RTSA for cuff tear arthropathy. 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).
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).
Essentially no significant differences were found between groups for any postoperative measure.
No differences in complications, notching, or narcotic use were noted between groups. The immediate-therapy group had 1 glenosphere dissociation requiring surgery (<1 month postoperatively), 1 acromial stress fracture managed nonoperatively, and 1 postoperative pulmonary embolism. The delayed-therapy group had 1 prosthetic shoulder dislocation requiring surgery (<1 month postoperatively), 1 periprosthetic fracture (at 1 year postoperatively), 1 deep venous thromboembolism, and 1 case of lymphedema.
Comment: This is a well done study. The authors addressed a dilemma: on one hand, it is tempting to immobilize the shoulder in hopes of minimizing the risk of instability; on the other hand, immobilization is disabling and can lead to falls especially in the elderly.
Our practice is to customize the post RTSA rehabilitation based on (1) the trustworthiness, (2) the steadiness of the patient, and (3) the indications for the RTSA (noting that those having RSA for revision of a prior arthroplasty may be at increased risk for dislocation). For example, in a trustworthy but unsteady patient, we would endorse the patient's resumption of using a walker for support.
==
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
=====
To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
