Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Abstract

IntroductionThe use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2–6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes.Methods and analysisIn our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events.Ethics and disseminationThe Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals.Trial registration numberNetherlands Trial Register (NL7656).

Effects of evidence-based nursing combined with enhanced recovery after surgery on shoulder joint function and neurological function after arthroscopic rotator cuff injury repair

“…Active and passive exercises of finger joints, elbow and wrist joints can be carried out two days after surgery to restore joint movement and reduce the occurrence probability of apraxia muscular atrophy and postoperative stiffness. [16,17] ROM score and ASES score are the main indexes to evaluate shoulder joint function after ARCR; The higher the ROM score and ASES score, the better the shoulder joint function. Hagen et al [5] found that joint ROM such as flexion, extension and abduction in the early rehabilitation group after shoulder joint replacement was significantly improved compared with that in the delayed rehabilitation group, avoiding local tissue spasm and joint stiffness after surgery.…”

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

“…There's consensus about early mobilization in elderly patients to decrease inconvenient and limitation due to use of sling [34]. A recent review of literature shows no consensus for postoperative rehabilitation protocol after RSA and publications concerning rehabilitation protocol avec RSA in traumatology are very rare [14,[35][36][37]. Both groups have very satisfactory clinical and functional results comparatively to literature [8,11,38,39].…”

“…Rehabilitation protocols are based on common principles but its differ regarding to several variables: postoperative delay, authorized movements, active/passive work, short and long term precautions which can explication for a part of complications [37,40,41]. Concerning complications, only one case of luxation was reported.…”

Rate of improvement in shoulder strength after anatomic and reverse total shoulder arthroplasty

“…Later FE strength recovery may also be explained by greater limitations on rehabilitation in the immediate weeks after aTSA in an effort to protect the subscapularis repair. 5 , 10 Furthermore, the reliance on a healing subscapularis for shoulder stability after aTSA may result in pain that limits strength, whereas stability in rTSA is dependent on the deltoid. 10 , 11 , 12 , 18 These differences in the biomechanics, postoperative rehabilitation, and stability likely also explain the early loss of both ER and FE strength between baseline and 3 months after aTSA but not after rTSA ( Figure 1 , Figure 2 ).…”