scholarly journals Immediate Accelerated Shoulder Rehabilitation (IASR) vs. Standard Protocol following Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

2020 ◽  
Author(s):  
Paul DeVito ◽  
Ryan Hatch ◽  
Avias Raja ◽  
Lauren Smudge ◽  
Travis Cambronne ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The United States ◽  
Rehabilitation Program ◽  
Reverse Total Shoulder Arthroplasty ◽  
Postoperative Rehabilitation ◽  
Randomized Controlled ◽  
Post Surgery ◽  
Accelerated Rehabilitation ◽  
Reverse Total Shoulder

Abstract Background: Recently, the reverse total shoulder arthroplasty (rTSA) became the most frequently performed form of shoulder replacement in the United States and abroad. While physical therapy is universally accepted and routinely practiced, published postoperative rehabilitation guidelines and modifications are based on protocols developed in 1975. Since then, the principle components and temporal concepts of timing and intensity of postoperative rehabilitation and protected immobilization have been controversially applied and expertly discussed without a prevailing consensus. Comparative literature that prospectively addresses treatment differences, influences on outcomes, and superiority or inferiority versus control does not exist. Thus, the objective of this pilot study is to compare an accelerated and immediate active shoulder rehabilitation (IASR) rehabilitation program with standard care in patients following rTSA.Methods: A prospective, randomized, controlled, parallel-designed, two-armed, non-blinded, superiority pilot trial. The comparator arms are an accelerated rehabilitation (IASR) strategy versus standardized care following rTSA (CPT: 23472). The primary outcome measures will be the change from pre-surgical baseline to 52 weeks post-surgery in the American Shoulder and Elbow (ASES) score, Simple Shoulder Test (SST), and global health assessment (PROMIS-10. Secondary and tertiary outcomes will assess subscapularis integrity, implant status, and overall rehabilitation costs compared to formal control. Patients will be recruited from a single site (TRIA Orthopaedic Center, Bloomington, MN) neighboring the fourteenth largest US metropolitan area.Discussion: This trial will be the first study to compare the efficacy and safety of two different postoperative rehabilitation strategies for patients following rTSA. Further, this will be the first study to investigate an accelerated rehabilitation program without a period of protected immobilization following rTSA. Finally, the results will assist in the shared clinical and surgical treatment decision-making process.

scholarly journals Reverse Total Shoulder Arthroplasty in Proximal Humeral Fractures

2017 ◽  
pp. 46-51
Author(s):  
A. S. Petrosyan
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Rehabilitation Program ◽  
Reverse Total Shoulder Arthroplasty ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Postoperative Rehabilitation ◽  
Rotator Cuff Injuries ◽  
Reverse Total Shoulder

Primary reverse total shoulder arthroplasty was performed in 13 patients, aged 65 – 83 years, with three- and four-part (by Neer classification) proximal humeral fractures. Rotator cuff injuries and shoulder contractures of various degrees were present in all patients. Surgical technique and postoperative rehabilitation program were described in details. Treatment results were assessed roentgenologically by Constant-Murley score in 6 months, 1, 2 and 3 years after intervention. Reverse total shoulder arthroplasty enabled to achieve good functional outcomes and considerable pain relief even in elderly patients with compound fractures and rotator cuff injuries. 

scholarly journals Reverse total shoulder arthroplasty in proximal humeral fractures

2017 ◽  
Vol 24 (4) ◽  
pp. 46-51
Author(s):  
Armenak S. Petrosyan
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Rehabilitation Program ◽  
Reverse Total Shoulder Arthroplasty ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Postoperative Rehabilitation ◽  
Rotator Cuff Injuries ◽  
Reverse Total Shoulder

Primary reverse total shoulder arthroplasty was performed in 13 patients, aged 65 - 83 years, with three- and four-part (by Neer classification) proximal humeral fractures. Rotator cuff injuries and shoulder contractures of various degrees were present in all patients. Surgical technique and postoperative rehabilitation program were described in details. Treatment results were assessed roentgenologically by Constant-Murley score in 6 months, 1, 2 and 3 years after intervention. Reverse total shoulder arthroplasty enabled to achieve good functional outcomes and considerable pain relief even in elderly patients with compound fractures and rotator cuff injuries.

scholarly journals Effectiveness of formal physical therapy following total shoulder arthroplasty: A systematic review

2018 ◽  
Vol 12 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Peter K Edwards ◽  
Jay R Ebert ◽  
Chris Littlewood ◽  
Tim Ackland ◽  
Allan Wang
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Future Research ◽  
Routine Practice ◽  
Post Surgery ◽  
Reverse Total Shoulder

Background Physical therapy is considered routine practice following total shoulder arthroplasty. To date, current regimens are based on clinical opinion, with evidence-based recommendations. The aim of this systematic review was to evaluate the effectiveness of total shoulder arthroplasty physical therapy programmes with a view to inform current clinical practice, as well as to develop a platform upon which future research might be conducted. Methods An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane Library to March 2018 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken. Results A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain. No studies evaluated the effectiveness of physical therapy programmes in reverse total shoulder arthroplasty procedures. Discussion Restoring range of motion and strength following total shoulder arthroplasty is considered important for patients to obtain a good outcome post-surgery and, when applied early, may offer more rapid recovery. Given the rising incidence of total shoulder arthroplasties, especially reverse total shoulder arthroplasty, there is an urgent need for high-quality, adequately powered randomised controlled trials to determine the effectiveness of rehabilitation programmes following these surgeries.

Accelerated Rehabilitation following Reverse Total Shoulder Arthroplasty

2021 ◽  
Author(s):  
Jonathan Lee ◽  
Paolo Consigliere ◽  
Ernest Fawzy ◽  
Laura Mariani ◽  
Caroline Witney-Lagen ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Accelerated Rehabilitation ◽  
Reverse Total Shoulder

National utilization of reverse total shoulder arthroplasty in the United States

2015 ◽  
Vol 24 (1) ◽  
pp. 91-97 ◽  
Author(s):  
William W. Schairer ◽  
Benedict U. Nwachukwu ◽  
Stephen Lyman ◽  
Edward V. Craig ◽  
Lawrence V. Gulotta
Keyword(s):  
United States ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The United States ◽  
Reverse Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder

A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty

2020 ◽  
pp. 175857322093739
Author(s):  
Peter K Edwards ◽  
Jay R Ebert ◽  
Brendan Joss ◽  
Timothy Ackland ◽  
Allan Wang
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Active Group ◽  
Objective Measures ◽  
Post Surgery ◽  
Patient Reported ◽  
Active Rehabilitation ◽  
Reverse Total Shoulder

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).

scholarly journals Reverse total shoulder arthroplasty

2018 ◽  
Vol 3 (2) ◽  
pp. 58-69 ◽  
Author(s):  
Filippo Familiari ◽  
Jorge Rojas ◽  
Mahmut Nedim Doral ◽  
Gazi Huri ◽  
Edward G. McFarland
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The United States ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Neurological Injury ◽  
Neck Shaft Angle ◽  
Surgeon Experience ◽  
Reverse Total Shoulder

Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased. Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff. RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching. Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair. Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions.Cite this article: EFORT Open Rev 2018;3:58–69 DOI: 10.1302/2058-5241.3.170044

scholarly journals Accelerated Shoulder Rehabilitation after Reverse Total Shoulder Arthroplasty for Atraumatic Osteoarthritis: Study Protocol for a Single Center Randomized Controlled Trial

2019 ◽  
Author(s):  
Avais Raja ◽  
Travis Cambronne ◽  
Michael R Walsh
Keyword(s):  
Randomized Controlled Trial ◽  
Shoulder Arthroplasty ◽  
Controlled Trial ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Single Center ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Shoulder Motion ◽  
Reverse Total Shoulder

Abstract Background Reverse total shoulder arthroplasty has been successful in patients suffering from advanced degenerative osteoarthritis with rotator cuff insufficiency. The currently practiced physical rehabilitation after a shoulder rehabilitation does not allow shoulder motion until 6 weeks post-operatively. These patients are required to be in a sling to assist the patient in immobilizing the operated shoulder. An accelerated rehabilitation with immediate active shoulder motion has not been studied in the setting of a revere total shoulder arthroplasty. Methods This is a single center and single surgeon operated, randomized controlled trial. The primary objective is to compare patient reported shoulder function using the American Shoulder and Elbow Society (ASES) score and shoulder range of motion in patients undergoing the traditional physical rehabilitation and accelerated shoulder rehabilitation post reverse total shoulder arthroplasty. Secondary outcomes will include the Simple Shoulder Test (SST) score, Patient Reported Outcome Information System (PROMIS) Global Health-10, radiological parameters and subscapularis tear on ultrasound. Discussion The study will assess the effectiveness of an accelerated shoulder rehabilitation with immediate active shoulder motion after a reverse total shoulder arthroplasty in patients with atraumatic osteoarthritis.

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