Outcome of Accelerated Active Rehabilitation Protocol Following ‘Double Row’ Deltoid Repairs in 308 Patients with Reverse Shoulder Arthroplasty: A New Concept

Background: Postoperative deltoid rehabilitation plays a vital role in the outcome of reverse shoulder arthropalsty (RSA). Biomechanical study highlighted its importance to achieve better outcome with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion.

There is no consensus regarding a formal rehabilitation protocol postoperatively. Most of the protocols recommend start of active movement at the 7th week.

Objectives: To assess the safety and effectiveness of the accelerated active rehabilitation protocol following reverse shoulder total arthroplasty following a special robust “double row” equivalent intraosseous technique to reattach the deltoid to the acromion.

Methods: Immediately postoperatively starting with pendulum and passive stretching exercise. As soon as the patient can, instructed to perform the active deltoid rehabilitation regime, starting in the supine position using low weight high repetition, active forward flexion, abduction and external rotation. Avoiding forced internal rotation and pushing themselves out of chairs for 6 weeks postoperatively.

308 Patients, who had undergone RSA between 2007 and 2015, were prospectively reviewed. Mean follow-up was 4 years (range 1-10 years). Indications were rotator cuff arthropathy (172), rheumatoid arthritis (43), revision for failed resurfacing (21), proximal humerus fracture (38), osteoarthritis with glenoid deficiency (21), failed rotator repair (13).

Results: At 3 weeks, forward flexion improved to 80º, abduction 70º, external rotation 22º, Constant score (CS) to
39 points. At 3 months CS was 54 points, forward flexion 110º, abduction 100º, external rotation 25º. At final follow-up CS improved from 18 preoperatively to 63 points postoperatively, forward flexion from 60º to 130º, abduction from 53º to 121º and external rotation from 16º to 36º. ADLEIR score improved from
13 to 31.

Conclusions: We recommend use of robust “double row” equivalent intraosseous technique to reattach the deltoid to the acromion allowing implementation of accelerated active rehabilitation protocol following RSA. Achieving early recovery, good function and patient satisfaction.