Range of motion after reverse shoulder arthroplasty improved with early or delayed rehabilitation
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Published results showed significant and similar improvements in range of motion and other outcomes among patients who received either early or delayed rehabilitation after reverse total shoulder arthroplasty.
C. Benjamin Ma, MD, and colleagues randomly assigned 107 shoulders undergoing reverse total shoulder arthroplasty (Trabecular Metal reverse shoulder system, Zimmer Biomet) to receive either delayed rehabilitation or early rehabilitation. Delayed rehabilitation included no range of motion for 6 weeks, while early rehabilitation included immediate physical therapy for passive and active range of motion, according to researchers. Researchers recorded demographic characteristics, range of motion, American Shoulder and Elbow Surgeons scores and complications among all patients.
Results showed 80.3% of patients initially enrolled completed 1-year follow-up, including 44 shoulders in the delayed-therapy group and 42 shoulders in the immediate-therapy group. Researchers found a significant improvement in forward flexion and abduction in both groups by 3 months, as well as significant improvements in ASES scores by 6 weeks with continued improvement through 6 months. Patients in the delayed-therapy group had better ASES functional scores at 6 months compared with the immediate-therapy group, according to results. However, researchers noted no significant differences between the groups in any other postoperative measures. Researchers also found no differences between the groups for complications, notching or narcotic use.
“Self-directed early range of motion following reverse shoulder arthroplasty can have significant improvement in clinical outcomes without significant changes in complications,” Ma told Healio Orthopedics. – by Casey Tingle
Disclosures: Ma reports he previously received research support from Zimmer Biomet. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to TopMark A. Frankle, MD
In this well designed randomized single-blinded trial, the authors determined that early introduction of postoperative rehabilitation, as soon as 1 week after arthroplasty surgery, did not increase the risk of postoperative complications. In both rehabilitation scenarios, early and late rehabilitation resulted in consistent improvements as early as 6 weeks (composite ASES scores) and improvement of function by 3 months with the improvements plateaued at 6 months postoperatively.
The strength of this study is in its robust methodology and adequate follow up at 1 year. As in all studies involving reverse total shoulder to treat patients, there is a heterogeneity of pathology. For example, in the present study, the majority of patients had rotator cuff arthropathy, but the authors also included revision shoulder arthroplasty patients. The severity of bone loss and muscle atrophy may be quite different between the two groups of patients.
Although inclusion of various diagnostic subgroups does not detract from the study findings since overall improvement in both groups occurred, it does limit the ability to extrapolate how patients with cuff deficiency and minimal arthritis treated with alternative methods can be compared to the functional improvement in this group at 3 months.
Florida Orthopaedic Institute
University of South Florida
Temple Terrace, Florida
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