Comparative Study of Standard Rehabilitation Protocols and an Accelerated Protocol Following Reverse Total Shoulder Arthroplasty

Establish an accelerated rehabilitation protocol following reverse shoulder arthroplasty (rTSA) and evaluate its effectiveness against more conservative rehabilitation routines.

Between 2005 and 2016, 305 shoulders (273 patients, 32 bilateral) underwent a primary rTSA. Patients were divided in 3-groups depending on the rehabilitation protocol undertaken (6weeks, 3weeks and 1week of postoperative immobilisation respectively for group 1, 2 and 3). Antero-superior approach was used and a “double row” equivalent intraosseous technique was used to reattach the deltoid to the acromion. Constant Score (CS), Subjective Shoulder Value (SSV), Patient Satisfaction Score (PSS) were used and patients prospectively assessed both clinically and radiographically preoperatively, at 3weeks, 3months, 6months, 1-year and yearly postoperatively.

Mean age at surgery was 74.8 years (range 52 - 93). At 1 year follow-up, Constant Score (CS) improved from 15.5 (adjusted 22) to 63.2 (adjusted 89.6) in group 1 (n=134), from 22.1 (adjusted 30.4) to 63,3 (adjusted 91.1) in group 2 (n=141) and from 23,4 (adjusted 32.9) to 65 (adjusted 104) in group 3 (n=33). Pain improved from 14.4/15 preoperatively to 2.9/15 postoperatively in group 1, from 12,6/15 to 3,5/15 in group 2 and from 12,44/15 to 2,9/15 in group-3. Mean range of movement (ROM) improved to 131° flexion and 129° abduction in group 1, 150° flexion and 141° abduction in group 2 and 170° flexion and 156° abduction in group 3. No statistical significance differences were observed in CS, SSV, PSS and ROM in group 3 compared to group 1 and 2.

Despite no statistical significance differences, rehabilitation centred on deltoid conditioning and early passive and active recovery of the ROM allows quicker recovery, reliable outcome and reduce prolonged immobilisation discomfort. A strong repair of the deltoid is mandatory to reach this purpose.