Our Summary

This research paper focuses on the importance of early rehabilitation after a specific type of shoulder surgery, known as Reverse Total Shoulder Arthroplasty (RTSA). This surgery is often used to treat shoulder fractures in elderly patients. However, there’s no general agreement on how to manage rehabilitation after the operation.

The researchers looked at the medical records of 94 patients who had undergone this surgery to treat shoulder fractures, tracking their progress for at least two years. They used various tests to measure the patients’ mobility and function after the surgery.

The study found that patients who started rehabilitation the day after their surgery (D1) had better results than those who waited 30 days post-surgery (D30) before starting their rehabilitation. This was regardless of whether a part of the shoulder joint known as the tuberosities had healed.

The results suggest that the success of the RTSA surgery is not necessarily linked to the healing of the tuberosities but rather to early rehabilitation. This helps to reduce stiffness and improve the function of the operated shoulder. Thus, the study recommends early rehabilitation for better clinical outcomes after RTSA surgery.

FAQs

  1. What is Reverse Total Shoulder Arthroplasty (RTSA) and who is it commonly used for?
  2. What does the study suggest about the timing of rehabilitation after RTSA surgery?
  3. Does the success of the RTSA surgery depend on the healing of the tuberosities according to the study?

Doctor’s Tip

A doctor might advise a patient undergoing shoulder replacement surgery to start rehabilitation as soon as possible after the operation, as early rehabilitation has been shown to improve mobility and function in the shoulder. Starting rehabilitation the day after surgery may lead to better outcomes compared to waiting 30 days post-surgery before starting rehabilitation. This can help reduce stiffness and improve the overall function of the operated shoulder.

Suitable For

In general, patients who are recommended for shoulder replacement surgery are those who have severe shoulder pain and limited mobility that is not responding to conservative treatments such as physical therapy, medications, or injections. Common conditions that may warrant shoulder replacement surgery include severe arthritis, rotator cuff tears, fractures, or failed previous shoulder surgeries.

Specifically for Reverse Total Shoulder Arthroplasty (RTSA), patients who are typically recommended for this surgery are those with complex shoulder conditions such as irreparable rotator cuff tears, severe shoulder fractures, or arthritis with significant rotator cuff damage. These patients may have limited range of motion, difficulty lifting their arm, and pain that significantly affects their daily activities.

Additionally, patients who are older and may not be good candidates for traditional shoulder replacement surgery due to poor rotator cuff function or anatomy may also be recommended for RTSA. This procedure can provide better stability and function for these patients compared to traditional shoulder replacement surgery.

Overall, the decision to recommend shoulder replacement surgery, including RTSA, is made on a case-by-case basis by a team of healthcare professionals including orthopedic surgeons, physical therapists, and other specialists. It is important for patients to discuss their individual condition and treatment options with their healthcare provider to determine if shoulder replacement surgery is the best option for them.

Timeline

Before shoulder replacement:

  1. Patient experiences chronic shoulder pain, stiffness, and limited range of motion.
  2. Patient undergoes various diagnostic tests, such as X-rays and MRI scans, to determine the extent of the shoulder joint damage.
  3. Orthopedic surgeon recommends shoulder replacement surgery as the best treatment option.
  4. Patient undergoes pre-operative evaluations and consultations to prepare for surgery.

After shoulder replacement:

  1. Patient undergoes shoulder replacement surgery, which involves removing damaged parts of the shoulder joint and replacing them with artificial components.
  2. Patient is monitored closely in the hospital for pain management and to prevent complications.
  3. Patient begins physical therapy and rehabilitation exercises to improve strength, range of motion, and function of the shoulder.
  4. Patient follows a post-operative care plan, which may include wearing a sling, avoiding certain activities, and attending follow-up appointments with the surgeon.
  5. Patient gradually resumes normal activities and experiences improved shoulder function over time.
  6. Patient continues with regular physical therapy sessions to optimize the recovery process and maintain shoulder strength and mobility.

What to Ask Your Doctor

Some questions a patient should ask their doctor about shoulder replacement, specifically Reverse Total Shoulder Arthroplasty (RTSA), include:

  1. What is the expected recovery timeline after RTSA surgery?
  2. When can I start physical therapy and rehabilitation after the surgery?
  3. What exercises and activities should I avoid during the recovery period?
  4. How long will I need to wear a sling or brace after the surgery?
  5. What are the potential risks and complications associated with RTSA surgery?
  6. How long will it take for me to regain full range of motion and functionality in my shoulder?
  7. Will I need any additional surgeries or treatments in the future?
  8. What kind of pain management options will be available to me during the recovery process?
  9. How often will I need follow-up appointments after the surgery?
  10. Are there any specific lifestyle changes or modifications I should make to support my recovery and long-term shoulder health?

Reference

Authors: Tuphe P, Caubriere M, Hubert L, Lancigu R, Sakek F, Loisel F, Obert L, Rony L. Journal: Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2951-2957. doi: 10.1007/s00590-023-03505-1. Epub 2023 Mar 14. PMID: 36914883