2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Restriction Free Rehabilitation after Reverse Shoulder Arthroplasty with Lateralized Components and No Subscapularis Repair Is a Safe Management Strategy with a Low Complication Rate

Alexander Hoffer, MD, MSc, FRCSC, Vancouver CANADA
Megan Anderson, BA, Rochester, Minnesota UNITED STATES
Cara Lai, MD, Phoenix, AZ UNITED STATES
Joseph C. Brinkman, MD, Paradise Valley, AZ UNITED STATES
John M. Tokish, MD, Phoenix, Az UNITED STATES

Mayo Clinic, Phoenix, Arizona, UNITED STATES

FDA Status Cleared

Summary

RSA with lateralized components, no subscapularis repair, and restriction free rehabilitation resulted in a low complication rate, fast improvement in PROs, and similar PROs to the traditional RSA and rehabilitation protocol at 1-year postoperatively.

Abstract

Introduction

Recovery after Reverse shoulder Arthroplasty has been reported to take up to 1 year. With the advent of lateralized components and a de-emphasis on subscapularis repair, earlier return to full activity may be possible, but concerns persist regarding complications with early mobilization. The purpose of this study was to assess the complication rate and patient reported outcomes (PROs) after RSA with lateralized components, no subscapularis repair, and restriction free rehabilitation.

Methods

A retrospective review from 2019-2022 of RSAs performed by a single surgeon was conducted. Inclusion criteria were primary RSA for glenohumeral osteoarthritis (GHOA), irreparable rotator cuff tear (RCT), or rotator cuff arthropathy (RCA). Exclusion criteria were RSA for fracture, revision, intra-operative findings that required a non-accelerated rehabilitation protocol, refusal, or < 1-year follow-up. The surgical technique included a metal glenoid augment and lateralized components without subscapularis repair. The rehabilitation protocol included unlimited range of motion and activity and sling discontinuation after the anesthetic block wore off. Patient demographics, PROs including the SANE, PROMIS Pain Interference, Physical Function and Upper Extremity, ASES, and complications were collected. Major and minor complications were documented, and PROs were collected and compared using paired t-tests.

Results

The sample included 109 patients, 71 (65%) male, and 46 (42%) left shoulders. The mean age was 74 ± 7.1 years, and the mean follow-up was 22.3 ± 9.1 months. The most common indications were RCA (52%), GHOA (37%), and RCT (10%). The major complication rate was 5.5% (6/109), of which 1 was instability, and 5 were acromial stress fracture. Four of the 5 acromial stress fractures were incomplete or non-displaced, none required re-operation, and patients with an acromial stress fracture did not report decreased PROs compared to patients without an acromial stress fracture. The minor complication rate was 3.7% (4/109), of which 2 were hematoma, 1 was incidental, asymptomatic HO, and 1 was incidental, asymptomatic radiographic scapular notching. The reoperation rate was 0.9% (1/109) and consisted of a liner exchange for instability. All PROs significantly improved at the 3 month and 1-year timepoints compared to preoperative values. When cases without a complication were considered alone, the mean difference between the 3-month and 1-year SANE score was 4.9 (P = 0.04, CI: 0.2, 9.5) and did not meet the previously established minimally clinically important difference of 28.8.

Conclusion

RSA performed with lateralized augmented components, no subscapularis repair, and restriction free rehabilitation resulted in a low complication rate, rapid improvement in PROs, and similar PROs to the traditional RSA and rehabilitation protocol at 1-year postoperatively.