2019 ISAKOS Biennial Congress ePoster #1714
Accelerated Rehabilitation Protocol Following Reverse Total Shoulder Arthroplasty: A New Concept
Paolo Consigliere, MD, Reading, Berkshire UNITED KINGDOM
Jonathon Lee, PT, Reading UNITED KINGDOM
Ernest Fawzy, MSc, FRCS, London, London UNITED KINGDOM
Caroline Witney-Lagen, MD, Reading, Berkshire UNITED KINGDOM
Luis Natera, MD, Barcelona SPAIN
Andreas Leonidou, MD, Reading, Berkshire UNITED KINGDOM
Georgios Panagopoulos, MD, London UNITED KINGDOM
Giuseppe Sforza, Pratica Di Mare, Rome ITALY
Ruben Abraham, MD, FRCS, Reading, Berkshire UNITED KINGDOM
Juan Bruguera, MD, Pamplona SPAIN
Ehud Atoun, MD, Karakur ISRAEL
Ofer Levy, MD, MCh(Orth), FRCS, Reading, Berkshire UNITED KINGDOM
Reading Shoulder Unit, Reading, Berkshire, UNITED KINGDOM
The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Innovative Design Orthopaedics, Verso TSA
Summary
Establish an accelerated rehabilitation protocol following reverse shoulder arthroplasty (rTSA) and evaluate its effectiveness against more conservative rehabilitation routines.
Abstract
Aim
Establish an accelerated rehabilitation protocol following reverse shoulder arthroplasty (rTSA) and evaluate its effectiveness against more conservative rehabilitation routines.
Background
Use of rTSA has increased exponentially in recent years. Few articles outlining a structured and validated rehabilitation protocol exist. Slow conservative rehabilitation,
with prolonged immobilisation and delayed exercises, has been used in the past.
Methods
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), Satisfaction were used and patients prospectively assessed both clinically and radiographically preoperatively, at 3weeks, 3months, 6months, 1-year and yearly postoperatively.
Results
Mean age at surgery was 74.8 years (range 52 - 93). At 1year 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 and ROM in group-3 compared to group-1 and 2.
Conclusions
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.