Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review

Return to sport after shoulder arthroplasty: The role of fast-track rehabilitation in reverse shoulder arthroplasty

Introduction

Shoulder arthroplasty, encompassing Total Shoulder Arthroplasty (TSA) and Reverse Shoulder Arthroplasty (RSA), has become an essential treatment for severe glenohumeral arthritis and complex rotator cuff pathologies. This study evaluated and compared clinical outcomes and return-to-sport rates in TSA patients following standard rehabilitation protocol and RSA patients following fast rehabilitation protocol.

Material and Methods

This retrospective study analyzed 44 patients (TSA: 13; RSA: 31) treated between 2020 and 2023 with at least 12 months of follow-up. Participants engaged in regular upper-extremity sports preoperatively. Patients in the TSA group followed a standard rehabilitation protocol, whereas those in the RSA group were assigned a new standardized fast rehabilitation protocol. Clinical outcomes were assessed using the Constant-Murley Score (CS), Visual Analogue Scale (VAS) for pain, and return-to-sport rates.

Results

TSA patients showed a 100% return-to-sport rate, significantly higher than the 54.84% rate for RSA patients (p < 0.05). Functional outcomes were better in TSA (CS: 81 ± 13.18) compared to RSA (CS: 76.54 ± 8.3, p > 0.05). Within the RSA group, those who resumed sports had significantly higher CS scores (79.59 ± 7.41) than non-returners (73.21 ± 8.64, p < 0.05). Postoperative VAS was similarly low in both groups.

Conclusion

TSA patients exhibited superior return-to-sport rates and functional outcomes compared to RSA patients, highlighting TSA's biomechanical advantages.

Future advances in shoulder arthroplasty surgery

Shoulder arthroplasty has evolved significantly since the in 1950s when Charles Neer designed and implanted the first shoulder hemiarthroplasty. Various alterations in design and material properties over the decades have led us to the implants used today, with ever-improving longevity and patient outcomes. This narrative review aims to provide an overview of shoulder arthroplasty surgery, looking at the past, present and future advances in this rapidly evolving field of orthopaedics.