Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups

Abstract

Background: Rehabilitation after Reverse Shoulder Arthroplasty (RSA) is still object of discussion with no based evidence guidelines. The aim of this study was to test a personalized rehabilitation protocol for three different patients groups according to clinical and intraoperative parameters that can affect final outcomes after RSA.

Patients and methods: We retrospectively evaluated a consecutive series of 112 patients who underwent to RSA between 2013 and 2015. The average follow-up was 29.2 months. A preoperative and postoperative clinical and radiographic assessment was performed. According to clinical, radiographic and intraoperative parameters, we selected three groups dedicating each one a specific level of post surgical care.

Results: A statistically significant improvement was achieved from preoperative evaluation, regarding all analysed parameters. Notable improvements were reported in high care group: elevation improved of 63.9° despite of Group A 55.5° and Group B 54.5° and it resulted statistically significant (p< 0.05). Costant Score increased of 35.9%, despite of Group A and Group B respectively 40.6% and 34.8% (p> 0.05).

Conclusion: Our study shows that a personalized rehabilitation protocol can be effective improving clinical outcomes and decreasing complications rate, particularly in difficult management patients.

Level of evidence: Therapeutic Level IV.

Keywords: complications; onlay design; radiological results; rehabilitation protocol; reverse shoulder arthroplasty; scapular notching.

Conflict of interest statement

Conflict of interest Alfonso Maria Romano, Angelo Di Giunta and Massimiliano Susanna receive fees for consulting from Exactech. The other Authors declare no conflicts of interest related to the subject of this article. This project does not infringe the Italian ethical rules and the privacy of the patients.

Figures

Figure 1

A high care Group C patient: preoperative (top) and postoperative ROM (below).

Figure 2

Preoperative and postoperative X-Rays follow-up of each group: from left to right, Group A, B, C examples, respectively.