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Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up

Abstract

Introduction

Reverse shoulder arthroplasty shifts the rotational center of the shoulder joint caudally and medially to restore shoulder function in a rotator cuff deficient shoulder. Despite promising results in early- and mid-term follow-up, long-term loss in shoulder function has been described in the literature. A lack of exercise in elderly patients may be one reason for this loss in function. This study examines the functional benefits of physical therapy in the mid-term to long-term follow-up regarding the subjective and objective shoulder function.

Materials and methods

Twenty patients with a mean age of 73 years were included in this series. The study was performed as a single-center, prospective study. Initial indications for reverse shoulder arthroplasty were cuff tear arthropathy, failed anatomical shoulder arthroplasty, and fracture sequelae. The patients were clinically examined at a mean follow-up of 62 months using the Constant score (CS) and the DASH score for the operated and the non-operated shoulder. They were reevaluated using the same scores following a standardized physical therapy program of 6 weeks’ duration.

Results

The mean CS as well as the mean age- and gender-adjusted CS of the affected shoulder improved significantly from 53.5 points to 59.3 points, and 72.7–80.8%, respectively. The subcategories activities of daily living and range of motion of the CS improved significantly, whereas no significant improvement was observed for the subcategories pain and strength. Evaluating the contralateral shoulder, no significant change was observed for the age- and gender-adjusted CS and the CS as well as its subcategories. We found no significant difference in the CS comparing the different etiologies prior to physical therapy.

Discussion

Physical therapy plays an important role subsequent to reverse shoulder arthroplasty. It also has an effect in the mid-term to long-term follow-up regarding the range of motion as well as activities of daily living. However, physical therapy seems to have limited effect on the strength and the residual pain level.

Level of evidence

Level III.

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Fig. 1

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Authors

Contributions

All authors were involved in treating and evaluating the patients. SU and SG were involved in data analysis and writing of the paper. SH and SP were involved in prove reading of the manuscript. All authors have reviewed and agree with the contents of the final draft of this article as submitted.

Corresponding author

Correspondence to Stefan Greiner.

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Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Stephan Uschok, Sebastian Herrmann, Stephan Pauly, Carsten Perka and Stefan Greiner declare that they have no conflict of interest.

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Uschok, S., Herrmann, S., Pauly, S. et al. Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up. Arch Orthop Trauma Surg 138, 1347–1352 (2018). https://doi.org/10.1007/s00402-018-2977-y

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Keywords

  • Reverse shoulder arthroplasty
  • Delta prosthesis
  • Physical therapy
  • Postoperative treatment