There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation.
Methods
This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach.
Results
Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10–145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73–136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group.
Discussion
Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.
KimSHHaKIJungMW, et al.Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study. Arthroscopy2003; 19: 722–731.
2.
WillertTSchmidtTGehringJ, et al.Inverse Schulterprothese bei proximalen HumerusfrakturenReversed total shoulder arthroplasty for proximal humerus fractures. Obere Extremitat2017; 12: 177–182.
3.
GarciaGHTaylorSADePalmaBJ, et al.Patient activity levels after reverse total shoulder arthroplasty: what are patients doing?Am J Sports Med2015; 43: 2816–2821.
4.
LeeJConsiglierePFawzyE, et al.Accelerated rehabilitation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: e545–e557.
5.
SevivasNFerreiraNAndradeR, et al.Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression. J Shoulder Elbow Surg2017; 26: e265–e277.
6.
BullockGSGarriguesGELedbetterL, et al.A systematic review of proposed rehabilitation guidelines following anatomic and reverse shoulder arthroplasty. J Orthop Sports Phys Ther2019; 49: 337–346.
7.
LittlewoodCMorganMPittL, et al.Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: a survey of publicly facing information. Musculoskeletal Care2020; 18: 359–364.
8.
EdwardsPKEbertJRJossB, et al.A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty. Shoulder Elbow2021; 13: 557–572.
9.
HagenMSAllahabadiSZhangAL, et al.A randomized single-blinded trial of early rehabilitation versus immobilization after reverse total shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 442–450.
10.
PalmKBBlazarPEMannaJC, et al.Feasibility, effectiveness and patient satisfaction of telerehabilitation after thumb carpometacarpal arthroplasty and reverse total shoulder arthroplasty: a pilot study. J Telemed Telecare2021: 1357633X21999578. DOI: 10.1177/1357633X21999578
11.
PereiraVCBarretoJToméS, et al.Clinical and functional results of reverse total shoulder arthroplasty and postoperative rehabilitation protocol. Cureus2022; 14: e23322.
12.
RomanoAMOlivaFNastrucciG, et al.Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups. Muscles Ligaments Tendons J2017; 7: 263–270.
13.
UschokSHerrmannSPaulyS, et al.Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up. Arch Orthop Trauma Surg2018; 138: 1647–1652.
14.
MoffattMWhelanGGillP, et al.Effectiveness of early versus delayed rehabilitation following total shoulder replacement: a systematic review. Clin Rehabil2022; 36: 190–203.
15.
HennRF 3rdGhomrawiHRutledgeJR, et al.Preoperative patient expectations of total shoulder arthroplasty. J Bone Joint Surg Am2011; 93: 2110–2115.
16.
RauckRCSwarupIChangB, et al.Preoperative patient expectations of elective reverse shoulder arthroplasty. J Shoulder Elbow Surg2019; 28: 1217–1222.
17.
FranceschettiEGiovannetti de SanctisEGregoriP, et al.Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review. J ISAKOS2021; 6: 363–366.
18.
BulhoffMSattlerPBrucknerT, et al.Do patients return to sports and work after total shoulder replacement surgery?Am J Sports Med2015; 43: 423–427.
19.
Barnes LAFGranthamWJMeadowsMC, et al.Sports activity after reverse total shoulder arthroplasty with minimum 2-year follow-up. Am J Orthop (Belle Mead NJ)2015; 44: 68–72.
20.
SimovitchRWGerardBKBreesJA, et al.Outcomes of reverse total shoulder arthroplasty in a senior athletic population. J Shoulder Elbow Surg2015; 24: 1481–1485.
21.
LiuJNGarciaGHMahonyG, et al.Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total shoulder replacement. J Shoulder Elbow Surg2016; 25: 920–926.
22.
KollingCBorovacMAudigeL, et al.Return to sports after reverse shoulder arthroplasty—the Swiss perspective. Int Orthop2018; 42: 1129–1135.
23.
MoherDLiberatiATetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med2009; 151: 264–269.
24.
PhillipsBBallCSackettD, et al.Oxford centre for evidence-based medicine-levels of evidence (March 2009). 2009.
25.
SlimKNiniEForestierD, et al.Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg2003; 73: 712–716.
26.
SterneJACSavovićJPageMJ, et al.Rob 2: a revised tool for assessing risk of bias in randomised trials. Br Med J2019; 366: l4898.
27.
SchünemannHBrozekJGuyattG, et al.GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. In: SchünemannHBrozekJGuyattG, et al. (eds.). The GRADE Working Group, 2013.
28.
HigginsJThomasJChandlerJ, et al.Cochrane handbook for systematic reviews of interventions. In: HigginsJPTJamesTChandlerJ, et al. (eds). Cochrane, 2022.
29.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: n71.
30.
TashjianRZHungMKeenerJD, et al.Determining the minimal clinically important difference for the American shoulder and elbow surgeons score, simple shoulder test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. J Shoulder Elbow Surg2017; 26: 144–148.
31.
YoungBLCantrellCKHamidN. Classifications in brief: the Nerot-Sirveaux classification for scapular notching. Clin Orthop Relat Res2018; 476: 2454–2457.
32.
BuchmannSSchochCGrimC, et al.Rehabilitation following reverse shoulder arthroplasty. Obere Extremitat2019; 14: 269–283.
33.
BoudreauSBoudreauEDHigginsLD, et al.Rehabilitation following reverse total shoulder arthroplasty. J Orthop Sports Phys Ther2007; 37: 734–743.
34.
RheeYGChoNSMoonSC. Effects of humeral component retroversion on functional outcomes in reverse total shoulder arthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg2015; 24: 1574–1581.
35.
GillespieRJGarriguesGEChangES, et al.Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes. Orthop Clin North Am2015; 46: 49–56.
36.
RoutmanHD. Indications, technique, and pitfalls of reverse total shoulder arthroplasty for proximal humerus fractures. Bull Hosp Jt Dis (2013)2013; 71: 64–67.
37.
CastriciniRGaspariniGDi LuggoF, et al.Health-related quality of life and functionality after reverse shoulder arthroplasty. J Shoulder Elbow Surg2013; 22: 1639–1649.
38.
WalchGBacleGLadermannA, et al.Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience?J Shoulder Elbow Surg2012; 21: 1470–1477.
39.
MizunoNDenardPJRaissP, et al.The clinical and radiographical results of reverse total shoulder arthroplasty with eccentric glenosphere. Int Orthop2012; 36: 1647–1653.
40.
LeungBHorodyskiMStrukAM, et al.Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. J Shoulder Elbow Surg2012; 21: 319–323.
41.
De BiaseCFDelcoglianoMBorroniM, et al.Reverse total shoulder arthroplasty: radiological and clinical result using an eccentric glenosphere. Musculoskelet Surg2012; 96: S27–S34.
42.
KemptonLBBalasubramaniamMAnkersonE, et al.A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 571–576.
43.
KemptonLBBalasubramaniamMAnkersonE, et al.A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 968–974.
44.
KaloucheISevivasNWahegaonkerA, et al.Reverse shoulder arthroplasty: does reduced medialisation improve radiological and clinical results?Acta Orthop Belg2009; 75: 158–166.
45.
CazeneuveJFCristofariDJ. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res2009; 95: 325–329.
46.
KleinMJuschkaMHinkenjannB, et al.Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma2008; 22: 698–704.
47.
WernerCMSteinmannPAGilbartM, et al.Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am2005; 87: 1476–1486.
48.
RossMHopeBStokesA, et al.Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elbow Surg2015; 24: 215–222.
49.
WalkerMWillisMPBrooksJP, et al.The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg2012; 21: 514–522.
50.
SadoghiPVavkenPLeithnerA, et al.Impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 1138–1146.
51.
ReitmanRDKerzhnerE. Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop (Belle Mead NJ)2011; 40: 458–461.
52.
CuffDPupelloDViraniN, et al.Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am2008; 90: 1244–1251.
53.
FrankleMLevyJCPupelloD, et al.The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am2006; 88: 178–190.
54.
ChoCHRheeYGYooJC, et al.Incidence and risk factors of acromial fracture following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: 57–64.
55.
DalyRMRosengrenBEAlwisG, et al.Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study. BMC Geriatr2013; 13:71.
56.
YoungAASmithMMBacleG, et al.Early results of reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am2011; 93: 1915–1923.
57.
KhanWSLongoUGAhrensPM, et al.A systematic review of the reverse shoulder replacement in rotator cuff arthropathy, rotator cuff tears, and rheumatoid arthritis. Sports Med Arthrosc Rev2011; 19: 366–379.
58.
BoileauPAltaTDDecroocqL, et al.Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?J Shoulder Elbow Surg2019; 28: 437–444.
59.
BoileauPWatkinsonDHatzidakisAM, et al.Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg2006; 15: 527–540.
60.
FluryMPFreyPGoldhahnJ, et al.Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results. Int Orthop2011; 35: 53–60.
61.
EdwardsTBWilliamsMDLabriolaJE, et al.Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg2009; 18: 892–896.
62.
GalloRAGamradtSCMatternCJ, et al.Instability after reverse total shoulder replacement. J Shoulder Elbow Surg2011; 20: 584–590.
63.
ChalmersPNRahmanZRomeoAA, et al.Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg2014; 23: 737–744.
64.
HansenMLNayakANarayananMS, et al.Role of subscapularis repair on muscle force requirements with reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013)2015; 73: S21–S27.
65.
FriedmanRJFlurinPHWrightTW, et al.Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. J Shoulder Elbow Surg2017; 26: 662–668.
66.
van EssenTKornuijtAde VriesLMA, et al.Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study. BMJ Open2020; 10: e034934.
67.
KingJJDaltonSSGulottaLV, et al.How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?: a systematic review. Bone Joint J2019; 101-B: 627–634.
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