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Bardsley JL, Daw RLC, Gibson J, Brownson P, Guisasola I, Kent M, Parmar R, Smith MG. Physiotherapy treatment for reverse total shoulder arthroplasty: Results of a patient-centred rehabilitation guideline using functional and patient-reported outcome measures. Shoulder Elbow 2024; 16:330-335. [PMID: 38818106 PMCID: PMC11135195 DOI: 10.1177/17585732221133532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/13/2022] [Accepted: 09/24/2022] [Indexed: 06/01/2024]
Abstract
Rehabilitation after primary reverse total shoulder arthroplasty (RTSA) is accepted to be an essential component to successful outcome achievement, but successful rehabilitation approaches have yet to be well described in the literature. This retrospective review documents the outcomes of a cohort of 29 patients undergoing RTSA surgery with rehabilitation following the Upper Limb Treatment and Rehabilitation Advice (ULTRA) guideline (Appendix 1). The Oxford Shoulder Score, Quick Disabilities of the Arm, Shoulder and Hand score, range of movement (degrees of flexion, abduction and external rotation) and numerical rating score for pain were prospectively collected pre-operatively and at one- and two-years post-operatively. Scores were then evaluated to establish whether or not there were any significant changes over time. Statistically significant improvements were seen in all outcome domains from pre-operative to one-year post-operative. All improvements met the threshold for achieving substantial clinical benefit as well as exceeding the minimum clinically important difference, and all improvements were maintained at the two-year post-operative time point. The present study showed that following the ULTRA guideline after elective RTSA can give statistically significant improvements in range of movement, pain score and patient-reported outcome at one-year post-operatively, which can be maintained up to two-years post-operatively.
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Affiliation(s)
- Jenna L Bardsley
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Rachael LC Daw
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jo Gibson
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Peter Brownson
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Inigo Guisasola
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Matthew Kent
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Rishee Parmar
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Matthew G Smith
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
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Yendluri A, Chiang JJ, Linden GS, Megafu MN, Galatz LM, Parsons BO, Parisien RL. The fragility of statistical findings in the reverse total shoulder arthroplasty literature: a systematic review of randomized controlled trials. J Shoulder Elbow Surg 2024; 33:1650-1658. [PMID: 38281679 DOI: 10.1016/j.jse.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has seen increasing utilization as an effective intervention for a wide variety of shoulder pathologies. The scope and indications for growth are often driven by findings from randomized controlled trials (RCTs) guiding surgical decision-making for RTSA. In this study, we utilized the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the robustness of outcomes reported in RCTs in the RTSA literature. METHODS PubMed, Embase, and MEDLINE were queried for RCTs (Jan. 1, 2010-Mar. 31, 2023) in the RTSA literature reporting dichotomous outcomes. The FI and rFI were defined as the number of outcome reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The FQ was determined by dividing the FI by the sample size of each study. Subgroup analysis was performed based on outcome category. RESULTS One hundred seventy-six RCTs were screened with 18 studies included. The median FI across 59 total outcomes was 4 (interquartile range [IQR]: 3-5) with an associated FQ of 0.051 (IQR: 0.029-0.065). Thirteen outcomes were statistically significant with a median FI of 3 (IQR: 1-4) and FQ of 0.033 (IQR: 0.012-0.066). Forty-six outcomes were nonsignificant with a median rFI of 4 (IQR: 3-5) and FQ of 0.055 (IQR: 0.032-0.065). The most fragile outcome category was revision/reoperations with a median FI of 2.50 (IQR: 1.00-3.25), followed by clinical score/outcome (median FI: 3.00), complications (median FI: 4.00), "other" (median FI: 4.00), and radiographic findings (median FI: 5.00). Notably, the number of patients lost to follow-up was greater than or equal to the FI for 59% of outcomes. CONCLUSION The statistical findings in RTSA RCTs are fragile and should be interpreted with caution. Reversal of only a few outcomes, or maintaining postoperative follow-up, may be sufficient to alter significance of study findings. We recommend standardized reporting of P values with FI and FQ metrics to allow clinicians to effectively assess the robustness of study findings.
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Affiliation(s)
- Avanish Yendluri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | - Michael N Megafu
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mehta N, Acuna AJ, McCormick JR, Harkin WE, Swindell HW, Defroda SF, Reinold M, Nicholson GP, Garrigues GE. Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations. Int J Sports Phys Ther 2024; 19:856-867. [PMID: 38966826 PMCID: PMC11221330 DOI: 10.26603/001c.118926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/04/2024] [Indexed: 07/06/2024] Open
Abstract
Background In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). Conclusion Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. Level of Evidence 3b.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic SurgeryRush University
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Choda N, Kanata Y, Kodama N, Iwasa S, Kawaguchi T, Uchiyama Y, Futani H, Domen K. Rehabilitation Treatment of a Patient With Total Humeral Endoprosthetic Replacement. Cureus 2024; 16:e60716. [PMID: 38903370 PMCID: PMC11187010 DOI: 10.7759/cureus.60716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
Total humeral endoprosthetic replacement (THR) is a rare surgery for malignant humeral bone tumors. Studies focusing on its surgical methods and functional status are limited. Furthermore, rehabilitation treatment after THR has not been reported. Therefore, this case report aimed to investigate its postoperative rehabilitation treatment and reinstatement. A 69-year-old woman was diagnosed with chondrosarcoma of her left humerus. THR was performed the day following patient admission. The wide resection caused the loss of her left shoulder motor function. She had a left ulnar nerve disorder and carpal tunnel syndrome. Rehabilitation treatments such as joint range of motion training were initiated on postoperative day (POD) 1. We designed a shoulder abductor brace to maintain her left shoulder in an abducted and flexed position so she could use her left hand effectively. The manual muscle testing scores for elbow joint movements gradually improved. On POD47, she was transferred to a convalescent rehabilitation hospital to receive training in activities of daily living and barber work. The patient was discharged on POD107. The Disabilities of the Arm, Shoulder, and Hand score improved from 86.2 (POD7) to 17.2 (POD107). She continued outpatient rehabilitation and reinstated work on POD143. The use of a brace and seamless rehabilitation from the acute phase to convalescence and community-based rehabilitation enabled the patient with THR to return to work. This study suggests that precise assessment of the disorders and consecutive rehabilitation treatment with a brace should be considered after THR.
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Affiliation(s)
- Naoki Choda
- Rehabilitation Center, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
- Department of General Medicine and Community Health Science, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
| | - Yoshihiro Kanata
- Rehabilitation Center, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
- Department of General Medicine and Community Health Science, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
| | - Norihiko Kodama
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Nishinomiya, JPN
| | - Saya Iwasa
- Rehabilitation Center, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
- Department of General Medicine and Community Health Science, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN
| | - Takayuki Kawaguchi
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, JPN
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
| | - Hiroyuki Futani
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, JPN
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
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Sachinis NP, Yiannakopoulos CK, Berthold DP, Franz A, Beitzel K. Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review. Shoulder Elbow 2024; 16:214-227. [PMID: 38655406 PMCID: PMC11034463 DOI: 10.1177/17585732221144007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 04/26/2024]
Abstract
Background 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.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K Yiannakopoulos
- IASO Hospital, Athens, Greece
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
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Sgaglione MW, Solasz SJ, Leucht P, Egol KA. Is Postoperative Splinting Advantageous After Upper Extremity Fracture Surgery? Results From the Arm Splint Pain Improvement Research Experiment. J Orthop Trauma 2024; 38:e92-e97. [PMID: 38117579 DOI: 10.1097/bot.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES The authors report no conflict of interest.To determine if short-term immobilization with a rigid long arm plaster elbow splint after surgery of the arm, elbow, or forearm results in superior outcomes compared with a soft dressing with early motion. METHODS DESIGN Prospective Randomized Control Trial. SETTING Academic Medical Center. PATIENT SELECTION CRITERIA Patients undergoing operative treatment for a mid-diaphysis or distal humerus, elbow, or forearm fracture were consented and randomized according to the study protocol for postoperative application of a rigid elbow splint (10-14 days in a plaster Sugar Tong Splint for forearm fracture or a Long Arm plaster Splint for 10-14 for all others) or soft dressing and allowing immediate free range of elbow and wrist motion (range of motion [ROM]). OUTCOME MEASURES AND COMPARISONS Self-reported pain (visual analog score or VAS), Healthscale (0-100, 100 denoting excellent health), and physical function (EuroQol 5 Dimension or EQ-5D) surveyed on postoperative days 1-5 and 14 were compared between groups. Patient-reported pain score (0-10, 10 denoting highest satisfaction) at week 6, time to fracture union, ultimate disabilities of the arm, shoulder, and hand score, and elbow ROM were also collected for analysis. Incidence of complications were assessed. RESULTS Hundred patients (38 men to 62 women with a mean age of 55.7 years) were included. Over the first 5 days and again at postop day 14, the splint cohort reported a higher "Healthscale" from 0 to 100 than the nonsplint group on all study days ( P = 0.041). There was no difference in reported pain between the 2 study groups over the same interval ( P = 0.161 and 0.338 for least and worst pain, respectively), and both groups reported similar rates of treatment satisfaction ( P = 0.30). Physical function ( P = 0.67) and rates of wound problems ( P = 0.27) were similar. Additionally, the mean time to fracture healing was similar for the splint and control groups (4.6 ± 2.8 vs. 4.0 ± 2.2 months, P = 0.34). Ultimate elbow ROM was similar between the study groups ( P = 0.48, P = 0.49, P = 0.61, and P = 0.51 for elbow extension, flexion, pronation, and supination, respectively). CONCLUSIONS Free range of elbow motion without splinting produced similar results compared with elbow immobilization after surgical intervention for a fracture to the humerus, elbow, and forearm. There was no difference in patient-reported pain outcomes, wound problems, or elbow ROM. Immobilized patients reported slightly higher "healthscale" ratings than nonsplinted patients and, however, reported similar rates of satisfaction. Both treatment strategies are acceptable after upper extremity fracture surgery. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew W Sgaglione
- New York University Langone Orthopedic Hospital, Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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7
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Alben MG, Gambhir N, Kingery MT, Halpern R, Papalia AG, Kwon YW, Zuckerman JD, Virk MS. No difference in complications between two-week vs. six-week duration of sling immobilization after reverse total shoulder arthroplasty. JSES Int 2023; 7:2486-2491. [PMID: 37969500 PMCID: PMC10638591 DOI: 10.1016/j.jseint.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of our study was to compare the outcomes and complications after a two- vs. six-week duration of sling immobilization following reverse total shoulder arthroplasty (rTSA). Methods We conducted a retrospective review from our institutional database on 960 patients treated by primary rTSA between 2011 and 2021. Patients were separated into two cohorts of postoperative sling immobilization (a two-week and six-week group). Multivariate analysis was conducted to evaluate what factors were associated with patients experiencing either a postoperative complication or requiring reoperation. Results A total of 276 patients were instructed to keep their operative arm in a sling for six weeks postoperatively, and 684 patients discontinued use at two weeks. There was no difference in postoperative complication rate (15.0% vs. 12.0%, P = .21), dislocation rate (P = .79), acromion stress fractures (P = .06), implant loosening (P = .15), and periprosthetic joint infections (P = .48) between the six- and two-week sling cohorts. In the immediate 90-day postoperative time period, no difference was seen in the reoperation rates (P = .73). Discussion Shorter duration of sling immobilization (two weeks) does not incur additional risk of complications compared to standard duration (six weeks) of sling immobilization following rTSA.
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Affiliation(s)
- Matthew G. Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew T. Kingery
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Robert Halpern
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W. Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D. Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Tuphe P, Caubriere M, Hubert L, Lancigu R, Sakek F, Loisel F, Obert L, Rony L. Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2951-2957. [PMID: 36914883 PMCID: PMC10010947 DOI: 10.1007/s00590-023-03505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Reverse total shoulder arthroplasty (RSA) has revolutionized the management of proximal humerus fractures (PHF) in the elderly patients. There is few or no consensus regarding to management of postoperative rehabilitation in elderly patients. An early rehabilitation from D1 allowed better functional results compared to rehabilitation started to D30 independently from tuberosities consolidation. METHODS 94 patients operated on for PHF were evaluated retrospectively, with a minimum radio-clinical follow-up of 2 years. Clinical evaluation included mobilities and four functional scores: ASES, quick DASH, gross constant, weighted constant. Radiological evaluation was performed on a frontal shoulder X-ray with evaluation of tuberosities' consolidation. RESULTS The mean follow-up was 45 ± 19 months (24-88 months). Early rehabilitation was significantly associated with a better Constant Score (71.1 ± 17.2 vs. 56.4 ± 15.8; p < 0.001), better adjusted Constant score (92.4 ± 14.2 vs. 80.3 ± 19.5; p < 0.001), better quick DASH (22.8 ± 19.8 vs. 36.7 ± 21.3; p < 0.01), better ASES (78.6 ± 20.2 vs. 63 ± 22; p < 0.001). CONCLUSION In traumatology, functional result of RSA seems not related in tuberosities' union but in rehabilitation in order to limit postoperative stiffness of operated shoulder. An early rehabilitation is related with better clinical and functional results, independently of tuberosities' union. LEVEL OF EVIDENCE 3, control-case study.
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Affiliation(s)
- P Tuphe
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - M Caubriere
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - L Hubert
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - R Lancigu
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - F Sakek
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - F Loisel
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - L Obert
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - L Rony
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France.
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
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Wang Z, Wang R, Gao C. Effect of knee arthroscopic debridement combined with peripatellar denervation on restoration of knee function in patients with knee osteoarthritis. BMC Surg 2023; 23:229. [PMID: 37568189 PMCID: PMC10422829 DOI: 10.1186/s12893-023-02113-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This research examines knee osteoarthritis (OA), a prevalent orthopedic disease marked by cartilage degeneration and chronic synovitis, leading to pain, restricted mobility, and eventual loss of knee function. Notably, patellofemoral osteoarthritis constitutes a significant proportion of knee OA cases. Our study aims to assess the impact of knee arthroscopic debridement coupled with peripatellar denervation on restoring knee function in OA patients and analyze the risk factors affecting treatment outcomes. By doing so, we hope to contribute to the informed selection of clinical treatment plans, addressing a disease that, if untreated, significantly impairs patients' quality of life. METHODS A total of 211 patients with knee osteoarthritis treated in our hospital from June 2020 to June 2022 were analyzed retrospectively. Among them, 116 patients received arthroscopic knee debridement treatment alone as the control group, and 95 in the observation group were combined with denervation treatment based on the control group. The clinical efficacy of the two groups of patients after treatment was evaluated, and patients' pain was counted using the pain visual analogue score (VAS) method. The knee range of motion (ROM) was used to count the mobility of the patients and to compare the operative time, intraoperative perfusion volume, and length of stay between the two groups. According to the effectiveness after treatment, patients were divided into the improvement group (effective + markedly effective) and the non-improvement group, and the risk factors affecting the clinical efficacy of patients after treatment were analyzed by logistic regression. RESULTS The total treatment efficiency of patients in the control group was lower than that of those in the observation group (P < 0.05). There was no difference in intraoperative perfusion volume and length of stay between patients in both groups (P > 0.05). However, the operative time was shorter in the control group compared with that in the observation group (P < 0.001). The post-treatment VAS scores of patients in the observation group were lower than those in the control group, while the ROM scores were higher than those of the control group (P < 0.001). Age, BMI, and preoperative VAS score were found to be independent risk factors for patient outcome by logistic regression analysis (P < 0.05). CONCLUSION knee arthroscopic debridement combined with peripatellar denervation has a significant improvement in the restoration of knee function in patients with knee osteoarthritis and reduces their level of pain.
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Affiliation(s)
- Zhijia Wang
- Department of Bone Trauma and Arthrology, Huai'an Hospital, No. 19, Shanyang Avenue, Huai'an District, Huai'an, 223200, Jiangsu Province, China
| | - Rui Wang
- Department of Bone Trauma and Arthrology, Huai'an Hospital, No. 19, Shanyang Avenue, Huai'an District, Huai'an, 223200, Jiangsu Province, China
| | - Congliang Gao
- Department of Bone Trauma and Arthrology, Huai'an Hospital, No. 19, Shanyang Avenue, Huai'an District, Huai'an, 223200, Jiangsu Province, China.
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Doyle TR, Hurley ET, Davey MS, Klifto C, Mullett H. The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:279-284. [PMID: 37588503 PMCID: PMC10426549 DOI: 10.1016/j.xrrt.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Reverse shoulder arthroplasty (RSA) is used in the treatment of traumatic and arthritic pathologies, with expanding clinical indications and as a result there has been an increase in clinical research on the topic. The purpose of this study was to examine the statistical fragility of randomized control trials (RCTs) reporting outcomes from RSA. A systematic search was undertaken to find RCTs investigating RSA. The Fragility Index (FI) was calculated using Fisher's exact test, by sequentially altering the number of events until there was a reversal of significance. The Fragility Quotient (FQ) was calculated by dividing the FI by the trial population. Each trial was assigned an overall FI and FQ calculated as the median result of its reported findings. Overall, 19 RCTs warranted inclusion in the review, representing 1146 patients, of which 41.2% were male, with a mean age of 74.2 ± 4.3 years and mean follow-up of 22.1 ± 9.9 months. The median RCT population was 59, with a median of 9 patients lost to follow-up. The median FI was 4.5, and median FQ was 0.083, indicating more patients did not complete the trial than the number of outcomes which would have to change to reverse the finding of significance. This review found that the RCT evidence for RSA management may be vulnerable to statistical fragility, with a handful of events required to reverse a finding of significance.
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Affiliation(s)
- Tom R. Doyle
- Sports Surgery Clinic, Santry, Dublin, Ireland
- Galway University Department of Surgery, Galway, Ireland
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11
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Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
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12
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Deng HM. Efficacy and safety of intravenous tranexamic acid in total shoulder arthroplasty: A meta-analysis. World J Clin Cases 2023; 11:2992-3001. [PMID: 37215404 PMCID: PMC10198082 DOI: 10.12998/wjcc.v11.i13.2992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) results in a large amount of perioperative blood loss due to severe trauma.
AIM To investigate the safety and efficacy of intravenous tranexamic acid (TXA) in TSA.
METHODS We searched the PubMed, Cochrane Library, Embase and Web of Science databases for randomized controlled trials (RCTs) on the use of TXA in TSA. And all the results were checked and assessed by Reference Citation Analysis (https://www.referencecitationanalysis.com/). A meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio (OR) or weighted mean difference (WMD) of related outcome indicators.
RESULTS A total of 5 RCTs with level 1 evidence were included. There were 369 cases, with 186 in the TXA group and 183 in the placebo group. The meta-analysis showed that TXA can significantly reduce total blood loss during the perioperative period [WMD = -249.56, 95% confidence interval (CI): -347.6 to -151.52, P < 0.0001], and the incidence of adverse reactions was low (OR = 0.36, 95%CI: 0.16-0.83, P = 0.02). Compared with the placebo group, the TXA group had significantly less total haemoglobin loss (WMD = -34.39, 95%CI: -50.56 to -18.22), less haemoglobin fluctuation before and after the operation (WMD = -0.6, 95%CI: -0.93 to -0.27) and less 24-h drain output (WMD = -136.87, 95%CI: -165.87 to -106.49). There were no significant differences in the operation time (P = 0.11) or hospital length of stay (P = 0.30) between the two groups.
CONCLUSION The application of intravenous TXA in the perioperative period of TSA can significantly reduce the total volume of perioperative blood loss and reduce the incidence of adverse reactions, so TXA is worthy of widespread clinical use.
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Affiliation(s)
- Hua-Mei Deng
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
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13
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Kornuijt A, de Vries L, van der Weegen W, Hillen RJ, Bogie R, Stokman R, van Kampen D. Direct active rehabilitation after reverse total shoulder arthroplasty: an international multicentre prospective cohort safety study with 1-year follow up. BMJ Open 2023; 13:e070934. [PMID: 37072366 PMCID: PMC10124285 DOI: 10.1136/bmjopen-2022-070934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES To gain insight in the safety of direct active rehabilitation without immobilisation in patients undergoing reverse total shoulder arthroplasty without subscapularis reattachment, measured by the occurrence of complications until 1-year follow up. Next, to explore improvement in shoulder function and in patient-reported outcome measures. DESIGN An international multicentre prospective cohort safety study. SETTING Patients indicated for reverse total shoulder arthroplasty, visiting the orthopaedics outpatient clinic at two hospitals in the Netherlands and one hospital in Curaçao between January 2019 and July 2021, were selected. PARTICIPANTS 100 patients (68% female, mean age 74±7.0 years) undergoing unilateral primary shoulder replacement were included if: ≥50 years, diagnosed with shoulder osteoarthritis, rotator cuff arthropathy or avascular necrosis, and selected for reverse total shoulder arthroplasty. A sling was used for only 1 day, followed by a progressive active rehabilitation for ≥12 weeks with no precautions. MAIN OUTCOME MEASURES Complications, range of motion and patient-reported outcome measures (Oxford Shoulder Score, Pain Numeric Rating Scale and EuroQol-5D for quality of life). Patients were evaluated preoperatively and 6 weeks, 3 months and 1 year postoperatively. RESULTS In total, 17 complications were registered (17.0%) including five (5.0%) categorised as potentially related to the rehabilitation strategy: one dislocation, one acromion fracture and three cases with persistent pain. Anteflexion, abduction and external rotation, pain scores and the Oxford Shoulder Score all improved significantly (p<0.05) at all time points compared with preoperative. Quality of life improved significantly from 3 months onwards. These secondary outcomes improved further until 1 year postoperatively. CONCLUSION Direct active rehabilitation after reverse total shoulder arthroplasty seems to be safe and effective. Potentially, this approach will lead to less dependent patients and faster recovery. Larger studies, preferably including a control group, should corroborate our results. TRIAL REGISTRATION NUMBER NL7656.
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Affiliation(s)
- Anke Kornuijt
- Sports and Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - Lieke de Vries
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
| | | | - Robert Jan Hillen
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
| | - Rob Bogie
- Sports and Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - Remco Stokman
- Orthopedic Surgery, Curaçao Medical Center, Willemstad, Curaçao
| | - Derk van Kampen
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
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14
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Chalmers PN, Tashjian RZ, Keener JD, Sefko JA, Da Silva A, Morrissey C, Presson AP, Zhang C, Chamberlain AM. Active physical therapy does not improve outcomes after reverse total shoulder arthroplasty: a multi-center, randomized clinical trial. J Shoulder Elbow Surg 2023; 32:760-770. [PMID: 36690173 DOI: 10.1016/j.jse.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/20/2022] [Accepted: 12/11/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare range of motion (ROM) and patient-reported outcomes (PROs) between a structured home exercise program (HEP) and active, supervised physiotherapy (PT) after primary Reverse total shoulder arthroplasty (RTSA) by performing a multicenter randomized clinical trial. METHODS Patients undergoing primary RTSA at 2 centers were randomized to either a HEP group, in which they were given a handout and a rope pulley, or a PT group, in which they were given a standardized prescription. Surgical technique and implants were standardized. At baseline, 6 weeks, 3 months, and 1 year postoperatively, we obtained American Shoulder and Elbow Surgeons scores, Western Ontario Osteoarthritis Scores, visual analogue scale for pain scores, and measured ROM via videotape. On video, ROM was then measured by blinded observers. At all study visits, patients were asked how many days per week they were in PT and how many days a week they completed HEP to determine compliance and crossover. An a priori power analysis suggested 29 patients per group, 56 patients total to detect a difference of 30° in active forward elevation with a power of 0.8 at a 2-sided alpha of 0.05. RESULTS 89 patients were randomized, 43 to PT, and 46 to HEP. We obtained 1-year PRO follow-up on 83 patients (93%) and ROM follow-up on 73 patients (82%). Nine patients (20%) crossed over from HEP to PT and 2 patients (4%) crossed over from PT to HEP. Complications occurred in 13% of HEP and 17% of PT patients (P = .629). Using mixed models that account for baseline values, there were no significant differences between groups in PROs or ROM at final follow-up. CONCLUSION In this 2-center, randomized clinical trial, there were no significant differences in patient outcomes or ROM between HEP and PT after RTSA. These findings suggest that it may not be necessary to recommend PT as a protocol for all patients after RTSA.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julianne A Sefko
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adrik Da Silva
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Caellagh Morrissey
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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15
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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16
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Polio W, Brolin TJ. Postoperative Rehabilitation After Shoulder Arthroplasty. Phys Med Rehabil Clin N Am 2023; 34:469-479. [PMID: 37003664 DOI: 10.1016/j.pmr.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Total shoulder arthroplasty (TSA), including anatomic TSA (aTSA) and reverse TSA (rTSA), has increased in popularity due to reliably good patient outcomes. Postoperative physical therapy (PT) is considered essential to the success of this operation and has become standard practice. The authors present general rehabilitation principles as well as preferred postoperative PT protocols for aTSA and rTSA, which are based on evidence-based literature and the different early postoperative concerns for each of these procedures.
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Affiliation(s)
- William Polio
- University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Tyler J Brolin
- University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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17
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Romiyo V, Patel MS, Rivera-Pintado C, Fedorka CJ. Two-day staged bilateral reverse shoulder arthroplasty for traumatic proximal humerus fractures: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:111-115. [PMID: 37588077 PMCID: PMC10426508 DOI: 10.1016/j.xrrt.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vineeth Romiyo
- Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Manan S. Patel
- Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ, USA
| | | | - Catherine J. Fedorka
- Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
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18
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Lu Z, Nazari G, Almeida PH, Pontes T, MacDermid JC. The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review. Disabil Rehabil 2022; 44:6997-7008. [PMID: 34618652 DOI: 10.1080/09638288.2021.1985633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population. METHODS A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria. RESULTS There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1-10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion. CONCLUSIONS High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4-6 weeks.Implications for RehabilitationThe reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.Our systematic review concluded that a 12-week PT program starting with immobilization for 4-6 weeks, followed by 3-4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.
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Affiliation(s)
- Ze Lu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Canada
| | - Goris Nazari
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
| | - Pedro H Almeida
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
| | - Tatiana Pontes
- Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Joy C MacDermid
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Canada.,School of Physical Therapy, Faculty of Health Science, Western University, London, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
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19
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Claes A, Mertens MG, Verborgt O, Baert I, Struyf F. Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review. Clin Rehabil 2022; 36:1369-1399. [PMID: 35698750 DOI: 10.1177/02692155221106627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize factors that are associated with a better treatment outcome after post-operative physical therapy in patients with shoulder arthroplasty. DATA SOURCES PubMed, Cochrane, and Web of Science. REVIEW METHODS Studies examining factors that are associated with a better outcome after post-operative physical therapy interventions in patients with shoulder arthroplasty were included. Two independent reviewers performed screening, extracted data, and assessed the risk of bias and level of evidence, using the Quality In Prognosis Studies tool and Evidence-Based Guideline Development checklist. PRISMA guidelines were followed. RESULTS In total, 460 articles were found and 14 studies were included. Two of the included articles had a moderate risk of bias, 12 high. The overall number of patients in the included studies varied from 20 to 2053. Patients had either a reverse (N = 1863), an anatomic total shoulder arthroplasty (N = 1029) or, a hemiarthroplasty (N = 133). Anatomic total shoulder arthroplasty patients with a neutral rotation sling position showed less night pain and greater range of motion, which was awarded moderate evidence. Other modifiable and non-modifiable factors such as telemedicine, immediate range of motion exercises, and pre-operative function were only awarded preliminary or conflicting evidence. CONCLUSION Mainly preliminary and conflicting evidence was found. The possible causes of the conflicting evidence were the different measurement methods, implant types, and follow-up times used. The methodological quality was low and physical therapy protocols differed greatly. More high-quality research with standardized protocols is needed to determine the association of various factors with treatment outcomes after post-operative physical therapy in patients with shoulder arthroplasty.
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Affiliation(s)
- Anke Claes
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Michel Gcam Mertens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Olivier Verborgt
- Department of Orthopaedic Surgery and Traumatology, University of Antwerp, Wilrijk, Belgium.,Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium.,MORE Foundation, Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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20
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Patch DA, Reed LA, Hao KA, King JJ, Kaar SG, Horneff JG, Ahn J, Strelzow JA, Hebert-Davies J, Little MTM, Krause PC, Johnson JP, Spitler CA. Understanding postoperative rehabilitation preferences in operatively managed proximal humerus fractures: do trauma and shoulder surgeons differ? J Shoulder Elbow Surg 2022; 31:1106-1114. [PMID: 35143996 DOI: 10.1016/j.jse.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humerus fractures (PHFs) are common, and their incidence is increasing as the population ages. Despite this, postoperative rehabilitation remains unstandardized and little is known about surgeon preferences. The aim of this study was to assess differences in postoperative rehabilitation preferences and patient education between orthopedic trauma and shoulder surgeons. METHODS An electronic survey was distributed to members of the Orthopaedic Trauma Association and the American Shoulder and Elbow Surgeons to assess differences in postoperative rehabilitation preferences and patient counseling. Descriptive statistics were reported for all respondents, trauma surgeons, and shoulder surgeons. Chi-square and unpaired 2-sample t tests were used to compare responses. Multinomial regression was used to further elucidate the influence of fellowship training independent of confounding characteristics. RESULTS A total of 293 surgeons completed the survey, including 172 shoulder and 78 trauma surgeons. A greater proportion of trauma surgeons preferred an immediate weightbearing status after arthroplasty compared to shoulder surgeons (45% vs. 19%, P = .003), but not after open reduction and internal fixation (ORIF) (62% vs. 75%, P = .412). A greater proportion of shoulder surgeons preferred home exercise therapy taught by the physician or using a handout following reverse shoulder arthroplasty (RSA) (21% vs. 2%, P = .009). A greater proportion of trauma surgeons began passive range of motion (ROM) <2 weeks after 2-part fractures (70% vs. 41%, P < .001). Conversely, a greater proportion of shoulder surgeons began passive ROM between 2 and 6 weeks for 2-part (57% vs. 24%, P < .001) and 4-part fractures (65% vs. 43%, P = .020). On multinomial regression analysis, fellowship training in shoulder surgery was associated with preference for a nonweightbearing duration of >12 weeks vs. 6-12 weeks after ORIF. Similarly, fellowship training in shoulder surgery was associated with increased odds of preferring a nonweightbearing duration of <6 weeks vs. no restrictions and >12 weeks vs. 6-12 weeks after arthroplasty. Training in shoulder surgery was associated with greater odds of preferring a nonweightbearing duration prior to beginning passive ROM of 2-6 weeks vs. <2 weeks or >6 weeks for 2-part fractures, but not 4-part fractures. CONCLUSION Trauma surgeons have a more aggressive approach to rehabilitation following operative PHF repair compared to shoulder surgeons regarding time to weightbearing status and passive ROM. Given the increasing incidence of PHFs and substantial variations in reported treatment outcomes, differences in rehabilitation after PHF treatment should be further evaluated to determine the role it may play in the outcomes of treatment studies.
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Affiliation(s)
- David A Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Logan A Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Scott G Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St Louis, MO, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jason A Strelzow
- Department of Orthopaedic Surgery, The University of Chicago, Chicago, IL, USA
| | - Jonah Hebert-Davies
- Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Milton T M Little
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Peter C Krause
- Department of Orthopaedic Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Joseph P Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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21
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Opioid Sparing at 24 h after Total Shoulder Arthroplasty by Undiluted Liposomal Bupivacaine Single Shot Interscalene Block: A Randomized Clinical Trial, First Results. SURGERIES 2022. [DOI: 10.3390/surgeries3010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to compare postoperative opioid consumption following total shoulder arthroplasty, after: (A) a single-shot undiluted liposomal bupivacaine (LB; commercial name: Exparel) interscalene block, or (B) a Ropivacaine block (R), supplemented with continuous catheter infusion. Methods: This prospective, randomized study (NCT03739021) compared postoperative analgesic requirements in Morphine Milligram Equivalent (MME) during the first 24 h after discharge from the post-anesthesia care unit (PACU) in patients receiving total shoulder arthroplasty. Two similar groups of 30 patients each received equivalent general operative anesthesia. Preoperative interscalene block was performed with either 10mL of undiluted liposomal bupivacaine (LB) or ropivacaine (R) 0.5% plus continuous catheter infusion. Results: There were no differences between the two groups regarding age, gender, length of surgery, intraoperative narcotic usage, or length of hospital stay. The time required to administer (LB) compared to (R) was significantly reduced (5 min vs. 15 min). The LB group experienced a reduction in MME during the first 24 h after PACU discharge (25 vs. 41 MME). Conclusion: A single shot of undiluted liposomal bupivacaine (LB) provided a significant (p = 0.045) reduction in opioid use during the first 24 h after shoulder replacement surgery compared to ropivacaine (R) with continuous catheter infusion. A larger sample group will be required to bolster these results. There was no measured difference in reported pain level. LB also took less time to administer.
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22
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VanHelmond TA, Iyer H, Lung BE, Kashanchi KI, Pearl M, Komatsu DE, Wang ED. Clinical outcomes following reverse total shoulder arthroplasty with tuberosity excision for treatment of proximal humerus fractures: a case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:56-63. [PMID: 37588277 PMCID: PMC10426692 DOI: 10.1016/j.xrrt.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment option for complex 3- and 4-part proximal humerus fractures in elderly patients. The literature has demonstrated that tuberosity repair likely improves postoperative range of motion (ROM). However, the difference between tuberosity repair and excision may not be appreciable to patients in their day-to-day lives. This case series reports both objective and subjective clinical outcomes of patients who underwent RTSA with tuberosity excision for proximal humerus fractures. Methods We reviewed the records of 41 patients who underwent RTSA for complex 3- and 4- part proximal humerus fractures. All RTSA procedures were performed by a single surgeon between 2014 and 2017. All patients underwent RTSA with extended proximal stem cementation and tuberosity excision. Postoperative outcomes were measured at least 2 years postoperatively and included ROM measurements for forward flexion, internal rotation, abduction, and external rotation. Patient-reported outcome measures included Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, and Penn Shoulder Score were also reported. Results In this case series, we report on 41 patients, 33 females and 8 males. Objective measurements of ROM for forward flexion, abduction, and external rotation were 125, 95, and 36 degrees, respectively. On average, patients had an internal rotation score of 2.06 and were able to get their thumb to their iliac crest. Clinical outcome scores of these patients were 9.11, 77.79, and 74.12 for the Simple Shoulder Test, American Shoulder and Elbow Surgeons, and Penn Shoulder Score, respectively. Strength of the deltoid was 5/5 in all 41 patients. Conclusions When compared with the current literature, our tuberosity excision patients demonstrated deficits in forward flexion and abduction, with preserved external rotation. Our clinical outcome score measurements were consistent with clinical outcome measurements from previous studies of patients undergoing RTSA with tuberosity repair. We believe that tuberosity excision may be a reasonable and simpler surgical option for surgeons with lower volumes of shoulder fractures and patients with multiple comorbidities and higher surgical risk, owing to the similarity of outcome scores between our cohort and previous tuberosity repair groups.
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Affiliation(s)
- Taylor A. VanHelmond
- Florida Atlantic University School of Medicine Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Hari Iyer
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brandon E. Lung
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Kevin I. Kashanchi
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Matthew Pearl
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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23
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Razmjou H, van Osnabrugge V, Anunciacion M, Nunn A, Drosdowech D, Roszkowski A, Szafirowicz A, Boljanovic D, Wainwright A, Nam D. Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty. J Shoulder Elb Arthroplast 2022; 5:24715492211023302. [PMID: 34993379 PMCID: PMC8492033 DOI: 10.1177/24715492211023302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. Results In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. Conclusion Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.
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Affiliation(s)
- Helen Razmjou
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Varda van Osnabrugge
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Anunciacion
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Nunn
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Darren Drosdowech
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Ania Roszkowski
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Analia Szafirowicz
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dragana Boljanovic
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Wainwright
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diane Nam
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Kennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, Nicholson G, Sears B, Wiesel B, Garrigues GE, Hagen C, Hong I, Roach M, Jones N, Mahendraraj K, Michaelson E, Bader J, Mauter L, Mengers S, Renko N, Strony J, Hart P, Steele E, Naylor A, Gaudette J, Sprengel K. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother 2021; 11:28. [PMID: 34886910 PMCID: PMC8662891 DOI: 10.1186/s40945-021-00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00121-2.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Lisa G M Friedman
- Department of Orthopedics, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC, 27701, USA.,Duke Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland, 11000 Euclid Ave, Cleveland, OH, 44106, United States
| | | | - Andrew Jawa
- Boston Sports and Shoulder Center, 40 Allied Dr., Suite 102, Dedham, MA, 02026, USA
| | - Peter Johnston
- Centers for Advanced Orthopaedics, 25500 Point Lookout Road, Leonardtown, MD, 20650, USA
| | - Sameer Nagda
- Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA, 22206, USA
| | - Gregory Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Benjamin Sears
- Western Orthopaedics, 1830 Franklin St, 450, Denver, CO, 80218, USA
| | - Brent Wiesel
- MedStar Orthopaedic Institute, 3800 Reservoir Road Northwest, Washington, DC, 20007, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
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25
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He L, Li Y, Liao X, Wang Y, Pu L, Gao F, Wang G. Effects of evidence-based nursing combined with enhanced recovery after surgery on shoulder joint function and neurological function after arthroscopic rotator cuff injury repair. Medicine (Baltimore) 2021; 100:e27951. [PMID: 34964778 PMCID: PMC8615422 DOI: 10.1097/md.0000000000027951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/02/2021] [Indexed: 01/05/2023] Open
Abstract
To explore the effect of Enhanced Recovery After Surgery (ERAS) nursing combined with limbs training on shoulder joint range of motion and neurological function of patients with rotator cuff injury after surgery.60 patients who underwent arthroscopic rotator cuff repair were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group received ERAS nursing combined with rehabilitation training, while the control group received routine nursing. The prognostic effects of nursing care and shoulder joint range of motion between the two groups were compared.There were differences in general indicators between the two groups (P = .001). There was no significant difference in the evaluation indexes of the two groups of patients (P > .05). The visual analog scale score and the degree of swelling of the affected limb of the experimental group were lower than those of the control group (P = .001; .001). After 1, 6, 12 weeks of treatment, the Constant-Murley, American Shoulder and Elbow Surgeons and University of California-Los Angeles scores of the experimental group were higher than those of the control group (P = .001; .001; .001). After 2, 4 weeks of treatment, the National Institutes of Health Stroke Scale scores of the experimental group were lower than those of the control group (P = .001). The self-efficacy evaluation of the experimental group was significantly better than that of the control group (P = .001); the complication rate was lower than that of the control group (P = .006).Compared with simple postoperative nursing recovery, ERAS nursing combined with limbs training can improve the exercise capacity of the shoulder joint and the recovery of neurological function, reduce the occurrence of complications.
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26
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Moffatt M, Whelan G, Gill P, Mazuquin B, Edwards P, Peach C, Davies R, Morgan M, Littlewood C. Effectiveness of early versus delayed rehabilitation following total shoulder replacement: A systematic review. Clin Rehabil 2021; 36:190-203. [PMID: 34723708 PMCID: PMC8807994 DOI: 10.1177/02692155211044137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To investigate the effectiveness of early versus delayed rehabilitation following total shoulder replacement. Design Intervention systematic review with narrative synthesis. Literature search MEDLINE, EMBASE, CINAHL, Scopus and the Cochrane Library were searched from inception to the 29th of July 2021. Study selection criteria Randomised controlled trials comparing early versus delayed rehabilitation following primary anatomic, primary reverse, or revision total shoulder replacement. Data synthesis A revised Cochrane risk of bias assessment tool for randomised controlled trials was used, as well as the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. A narrative synthesis was undertaken. Results Three eligible randomised controlled trials (n = 230) were included. There was very low-quality evidence of no statistically significant difference (P > 0.05) in pain, shoulder function, health-related quality of life or lesser tuberosity osteotomy healing at 12 months between early or delayed rehabilitation. There was conflicting and very low-quality evidence of a difference between the effect of early and delayed rehabilitation on shoulder range of movement. There was limited, very low-quality evidence of statistically significantly improved pain and function (P < 0.05) in the early post-operative period with early rehabilitation following anatomic total shoulder replacement. Conclusions No differences were seen in patient-reported or clinician-reported outcomes at 12 months post-surgery between early and delayed rehabilitation following total shoulder replacement. There is very low-quality evidence that early rehabilitation may improve shoulder pain and function in the early post-operative phase following anatomic total shoulder replacement.
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Affiliation(s)
- Maria Moffatt
- 5289Manchester Metropolitan University, Manchester, UK
| | - Gareth Whelan
- 8749York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Peter Gill
- 523611Northern Care Alliance NHS Group, Salford, UK
| | | | | | - Chris Peach
- 98564Manchester University Foundation Trust, Manchester, UK
| | - Ronnie Davies
- Manchester University Foundation Trust, Manchester, UK
| | - Marie Morgan
- 2102University Hospitals of Derby and Burton NHS, Derby, UK
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27
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Edwards PK, Ebert JR, Joss B, Ackland T, Wang A. A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty. Shoulder Elbow 2021; 13:557-572. [PMID: 34659491 PMCID: PMC8512973 DOI: 10.1177/1758573220937394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rehabilitation contributes to post-operative success following reverse total shoulder arthroplasty; however, randomised trials comparing the effectiveness of rehabilitation following reverse total shoulder arthroplasty are lacking. This study sought to determine if early, active mobilisation targeting the deltoid and the external rotator muscles, would exhibit greater improvements in post-operative outcomes compared to a delayed and deltoid-focused mobilisation programme. METHODS Patients scheduled for reverse total shoulder arthroplasty were randomly assigned to either an early active or delayed active rehabilitation group. Patient-reported outcomes for pain and function were assessed pre-surgery and at 3, 6 and 12 months post-surgery. Objective measures (Constant Score, range of motion, isometric strength) were assessed at 3, 6 and 12 months post-surgery. RESULTS Sixty-one patients (63 shoulders) underwent reverse total shoulder arthroplasty. There were no significant interaction effects or between-group differences for any patient-reported outcomes or objective measures at 3, 6 or 12 months post-surgery. However, significantly better (p = 0.019) active arm flexion was observed in the early active group at three months post-surgery. Significantly more patients in the early active group reported improvement in patient-reported function that reached minimal clinically important difference from three to six months post-surgery (p = 0.016). CONCLUSION Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme. LEVEL OF EVIDENCE Therapy, level 1b. Trial registered 15 June 2016 at www.anzctr.org.au (ACTRN12616000779471).
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of
Western Australia, Perth, Australia,School of Physiotherapy and Exercise
Science, Curtin University, Perth, Australia,Peter K Edwards, Curtin University, Building
408, Brand Drive Bentley, Western Australia 6102, Australia.
| | - Jay R Ebert
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Brendan Joss
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Timothy Ackland
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, The
University of Western Australia, Perth, Australia,Murdoch Centre of Orthopaedic Research,
Murdoch, Australia
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28
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Is outpatient shoulder arthroplasty safe? A systematic review and meta-analysis. J Shoulder Elbow Surg 2021; 30:1968-1976. [PMID: 33675972 DOI: 10.1016/j.jse.2021.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Amid rising health care costs and recent advances in surgical and anesthetic protocols, the rate of outpatient joint arthroplasty has risen steadily in recent years. Although the safety of outpatient total knee arthroplasty and total hip arthroplasty has been well established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study was to synthesize the current literature and provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty. METHODS A systematic review was conducted following the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse TSA. Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) comparing outpatient and inpatient shoulder arthroplasty. RESULTS Twelve studies were included, with a total of 194,513 patients, of whom 7162 were outpatients. Of the studies, 8 were level III and 4 were level IV. The average age of the outpatients was 66.6 years, and the average age of the inpatients was 70.1 years. The overall OR for complications was significantly lower in outpatients (OR, 0.40; 95% CI, 0.35-0.45) than in inpatients. There was no significant difference in rates of 90-day readmission (OR, 0.88; 95% CI, 0.75-1.03), revision (OR, 0.96; 95% CI, 0.65-1.41), and infection (OR, 0.93; 95% CI, 0.64-1.35) when comparing outpatients with inpatients. CONCLUSION Outpatient TSA, in an appropriately selected patient population, is safe and results in comparable patient outcomes to those of inpatient shoulder arthroplasty. Given the expected increase in the number of patients requiring TSA, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost- and care-efficient approach to total shoulder replacement.
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29
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Tashjian RZ, Christensen GV, Chalmers PN. What's New in Shoulder and Elbow Surgery. J Bone Joint Surg Am 2020; 102:1770-1776. [PMID: 33086343 DOI: 10.2106/jbjs.20.01252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
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30
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van Essen T, Kornuijt A, de Vries LMA, Stokman R, van der Weegen W, Bogie R, Hillen RJ, van Kampen DA. Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study. BMJ Open 2020; 10:e034934. [PMID: 32819933 PMCID: PMC7440714 DOI: 10.1136/bmjopen-2019-034934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The 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 ANALYSIS In 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 DISSEMINATION The 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 NUMBER Netherlands Trial Register (NL7656).
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Affiliation(s)
- Tom van Essen
- Orthopaedic Surgery, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - Anke Kornuijt
- Orthopaedic Surgery, Sint Annaziekenhuis, Geldrop, Noord-Brabant, The Netherlands
| | | | - Remco Stokman
- Orthopaedic Surgery, Sint Elisabeth Hospitaal, Willemstad, Curaçao
| | | | - Rob Bogie
- Orthopaedic Surgery, Sint Annaziekenhuis, Geldrop, Noord-Brabant, The Netherlands
| | - Robert Jan Hillen
- Orthopaedic Surgery, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - D A van Kampen
- Orthopedic Surgery and Traumatologie, Dijklander Ziekenhuis, Hoorn, The Netherlands
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31
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Littlewood C, Morgan M, Pitt L, Moffatt M, Edwards P, Davies R, Peach C. Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information. Musculoskeletal Care 2020; 18:359-364. [PMID: 32329209 DOI: 10.1002/msc.1468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The prevalence of shoulder arthroplasty (SA) is rising, but there is limited research evaluating rehabilitation following SA and whether there is an optimal approach remains unknown. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following SA as a platform for conducting much needed further research. METHODS Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following SA, for example, duration of immobilisation. One reviewer extracted data, and a second reviewer verified this. ETHICAL APPROVAL Not required. RESULTS Forty-three PIS from 40 Trusts were identified. Twenty-four referred to more than one type of arthroplasty (anatomic, reverse and hemiarthroplasty) but did not describe different approaches to rehabilitation based on prosthesis type. Twenty-five PIS provided some instruction regarding movement restrictions, which varied considerably. All PIS referred to postoperative immobilisation, typically with a sling, with median duration of 4 weeks (range 0 to 8). Thirty-four PIS reported commencing passive exercise immediately. Median time to commencing active exercise was 4 weeks (range 1 to 6) and 5 weeks (range 1 to 16) for resisted exercise. Median time expected to return to driving was 6 weeks (range 3 to 12) and general work 12 weeks (range 3 to 26). CONCLUSION This study has highlighted significant heterogeneity between rehabilitation approaches following SA, not previously reported in the United Kingdom, with a lack of specific rehabilitation PIS for different prosthesis types. Our results will facilitate evaluation of rehabilitation strategies in future research.
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Affiliation(s)
- Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Marie Morgan
- Derby Shoulder Unit, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
| | - Lisa Pitt
- Derby Shoulder Unit, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
| | - Maria Moffatt
- Upper Limb Research Unit, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Peter Edwards
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ronnie Davies
- Shoulder and Elbow Service, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Peach
- Shoulder and Elbow Service, Manchester University NHS Foundation Trust, Manchester, UK
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