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Perioperative Management in Reverse Total Shoulder Arthroplasty

  • Reverse Shoulder Arthroplasty (C Chambers and E Craig, Section Editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

A successful reverse total shoulder arthroplasty requires careful preoperative planning and perioperative management. Preoperative comorbidity risks, perioperative pain management, and postoperative rehabilitation are all critical components of this arthroplasty. The current review examines available literature to guide the perioperative care of the reverse total shoulder arthroplasty patient.

Recent Findings

One of the most important advances for shoulder arthroplasty in recent years has been heightened awareness of various modalities for perioperative pain management. A number of recent studies have focused on the options for regional blockade as a critical tool for postoperative pain relief and the use of either continuous interscalene blocks or single shot blocks are supported. Additional studies are necessary to define the best local anesthetic agent and delivery mechanism to provide appropriate pain relief with a low side effect profile.

Summary

Management of the patient throughout the perioperative course is a critical component in achieving better patient outcomes delivering high quality patient care. An orthopedic surgery team focused on perioperative management is better positioned to decrease adverse events and improve patient outcomes after reverse total shoulder arthroplasty.

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References

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  1. Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J. Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2017;1(3):72–80. https://doi.org/10.1302/2058-5241.1.160003 eCollection.

    Article  PubMed  Google Scholar 

  2. Theodoulou A, Krishnan J, Aromataris E. Risk of poor outcomes in patients who are obese following total shoulder arthroplasty and reverse total shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elb Surg. 2019 Nov;28(11):e359–76. https://doi.org/10.1016/j.jse.2019.06.017.

    Article  Google Scholar 

  3. Casp AJ, Montgomery SR Jr, Cancienne JM, Brockmeier SF, Werner BC. Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2019;28:121–7. https://doi.org/10.5435/JAAOS-D-18-00537.

    Article  Google Scholar 

  4. Bronson WH. Ethics of provider risk factor modification in total joint arthroplasty. J Bone Joint Surg Am. 2015;97(19):1635–9. https://doi.org/10.2106/JBJS.O.00564The current environment of limited health-care resources demands efficient delivery of medical care to achieve a financially sustainable health-care model. Several initiatives in the Patient Protection and Affordable Care Act (PPACA) of 2010 require that hospitals simultaneously improve quality and decrease the cost of care or face financial penalties. One strategy to achieve more efficient care is to decrease the number of risk factors with which patients present prior to a surgical procedure such as total joint arthroplasty. We believe that it is moral to engage in patient risk factor modification prior to elective joint replacement.

    Article  PubMed  Google Scholar 

  5. Beazley J, Evans JP, Furness ND, Smith CD. Comparative learning curves for early complications in anatomical and reverse shoulder arthroplasty. Ann R Coll Surg Engl. 2018;100(6):491–6. https://doi.org/10.1308/rcsann.2018.0062.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Singh A, Yian EH, Dillon MT, Takayanagi M, Burke MF, Navarro RA. The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics. J Shoulder Elb Surg. 2014;23(8):1187–94. https://doi.org/10.1016/j.jse.2013.11.017.

    Article  Google Scholar 

  7. Paxton ES, Green A, Krueger VS. Periprosthetic infections of the shoulder: diagnosis and management. J Am Acad Orthop Surg. 2019;27(21):e935–e44.

    Article  Google Scholar 

  8. Saltzman MD, Marecek GS, Edwards SL, Kalainov DM. Infection after shoulder surgery. J Am Acad Orthop Surg. 2011;19(4):208–18.

    Article  Google Scholar 

  9. Marecek GS, Weatherford BM, Fuller EB, Saltzman MD. The effect of axillary hair on surgical antisepsis around the shoulder. J Shoulder Elb Surg. 2015;24(5):804–8.

    Article  Google Scholar 

  10. Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Deep infection after rotator cuff repair. J Shoulder Elb Surg. 2007;16(3):306–11.

    Article  Google Scholar 

  11. Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN. Infection after mini-open rotator cuff repair. J Shoulder Elb Surg. 2002;11(6):605–8.

    Article  Google Scholar 

  12. Garrigues GE, Zmistowski B, Cooper AM, Green A, Group IS. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: prevention of periprosthetic shoulder infection. J Shoulder Elb Surg. 2019;28(6S):S13–31 The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. Over 800 international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology were assembled to form a consensus workgroup. The following proceedings on the prevention of periprosthetic shoulder infection come from 16 questions evaluated by delegates from the shoulder section.

    Article  Google Scholar 

  13. Dizay HH, Lau DG, Nottage WM. Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder arthroscopy. J Shoulder Elb Surg. 2017;26(7):1190–5.

    Article  Google Scholar 

  14. Mook WR, Klement MR, Green CL, Hazen KC, Garrigues GE. The incidence of propionibacterium acnes in open shoulder surgery: a controlled diagnostic study. J Bone Joint Surg Am. 2015;97(12):957–63.

    Article  Google Scholar 

  15. Scheer VM, Bergman Jungeström M, Lerm M, Serrander L, Kalén A. Topical benzoyl peroxide application on the shoulder reduces Propionibacterium acnes: a randomized study. J Shoulder Elb Surg. 2018;27(6):957–61.

    Article  Google Scholar 

  16. Rao A, Chalmers P, Cvetanovich G, O'Brien M, Newgren J, Nikhil V, et al. Preoperative doxycycline does not reduce Propionibacterium acnes in shoulder arthroplasty. 2018.

  17. Kuo LT, Hsu WH, Chi CC, Yoo JC. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19(1):60 Background: The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events. Results: We identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to - 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to - 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to - 71.70), less change in hemoglobin (MD - 0.64 g/dl, 95% CI -0.86 to - 0.42), and less blood loss via drainage (MD - 84.56 ml, 95% CI -145.72.14 to - 23.39) than non-TXA group. Conclusions: The use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA.

    Article  Google Scholar 

  18. Botros M, Curry EJ, Yin J, Jawa A, Eichinger JK, Li X. Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty. JSES Open Access. 2019;3(2):108–12.

    Article  Google Scholar 

  19. Garraud O, Sut C, Haddad A, Tariket S, Aloui C, Laradi S, et al. Transfusion-associated hazards: a revisit of their presentation. Transfus Clin Biol. 2018;25(2):118–35.

    Article  CAS  Google Scholar 

  20. Smucny M, Menendez ME, Ring D, Feeley BT, Zhang AL. Inpatient surgical site infection after shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(5):747–53.

    Article  Google Scholar 

  21. Moonen AF, Neal TD, Pilot P. Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury. 2006;37(Suppl 5):S11–6.

    Article  Google Scholar 

  22. Kopanidis P, Hardidge A, McNicol L, Tay S, McCall P, Weinberg L. Perioperative blood management programme reduces the use of allogenic blood transfusion in patients undergoing total hip and knee arthroplasty. J Orthop Surg Res. 2016;11:28.

    Article  Google Scholar 

  23. Friedman RJ, Gordon E, Butler RB, Mock L, Dumas B. Tranexamic acid decreases blood loss after total shoulder arthroplasty. J Shoulder Elb Surg. 2016;25(4):614–8 Background: Tranexamic acid (TXA) significantly decreases blood loss and transfusion rates after total hip and total knee arthroplasty. The purpose of this study was to determine the effects of intravenous TXA on blood loss and patient outcomes after total shoulder arthroplasty (TSA). Methods: TXA was used in 106 consecutive patients undergoing primary anatomic and reverse TSA with a dose of 20 mg/kg intravenously (TXA group) and compared with the previous consecutive 88 patients without TXA (non-TXA group). All patients had a blood sample drawn for a hemoglobin and hematocrit determination the morning after surgery. Analysis of variance and χ(2) techniques were used to analyze study hypotheses. Results: Statistically significant differences in both hemoglobin loss (TXA group Δ = 2.13 vs. non-TXA group Δ = 2.63; P = .01) and hematocrit loss (TXA group Δ = 6.4 vs. non-TXA group Δ = 8.14; P < .01) were seen in the TXA group compared with the non-TXA group. In patients receiving TXA, there were statistically significant decreases in the time spent in the recovery room (mean, TXA group 69 minutes vs. non-TXA group 87 minutes; P < .02) and total length of hospitalization (mean, TXA group 1.18 days vs. non-TXA group 1.4 days; P = .01). Two patients in the TXA group received a blood transfusion, whereas 6 patients in the non-TXA group did. Conclusions: TXA 20 mg/kg intravenously given just before primary anatomic and reverse TSA results in statistically significant reductions in blood loss. Patients spent 21% less time in the recovery room and had a 16% shorter hospitalization, resulting in financial savings for the hospital.

    Article  Google Scholar 

  24. Churchill JL, Puca KE, Meyer ES, Carleton MC, Truchan SL, Anderson MJ. Comparison of ε-aminocaproic acid and tranexamic acid in reducing postoperative transfusions in total hip arthroplasty. J Arthroplast. 2016;31(12):2795–9.e1.

    Article  Google Scholar 

  25. Tengborn L, Blombäck M, Berntorp E. Tranexamic acid--an old drug still going strong and making a revival. Thromb Res. 2015;135(2):231–42.

    Article  CAS  Google Scholar 

  26. Abildgaard JT, McLemore R, Hattrup SJ. Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2016;25(10):1643–8.

    Article  Google Scholar 

  27. Vara AD, Koueiter DM, Pinkas DE, Gowda A, Wiater BP, Wiater JM. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial. J Shoulder Elb Surg. 2017;26(8):1383–9.

    Article  Google Scholar 

  28. Pauzenberger L, Domej MA, Heuberer PR, Hexel M, Grieb A, Laky B, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty. Bone Joint J. 2017;99-B(8):1073–9.

    Article  CAS  Google Scholar 

  29. Gillespie R, Shishani Y, Joseph S, Streit JJ, Gobezie R. Neer Award 2015: a randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(11):1679–84.

    Article  Google Scholar 

  30. Trofa DP, Paulino FE, Munoz J, Villacis DC, Irvine JN, Jobin CM, et al. Short-term outcomes associated with drain use in shoulder arthroplasties: a prospective, randomized controlled trial. J Shoulder Elb Surg. 2019, 28(2):205–11 Background: This study examined the immediate outcomes during the perioperative period associated with drains in the setting of total shoulder arthroplasty or reverse shoulder arthroplasty. We hypothesized that drain use would result in lower postoperative hemoglobin and hematocrit levels that would increase transfusion rates and longer hospital stays that would increase hospital costs. Methods: The study prospectively randomized 100 patients (55% women; average age, 69.3 years) who underwent total shoulder arthroplasty or reverse shoulder arthroplasty to receive a closed-suction drainage device (drain group, n = 50) or not (control group, n = 50) at the time of wound closure. Basic demographic information and intraoperative and postoperative data were collected. Results: The groups were similar with respect to basic patient demographics. Postoperatively, drains had no effect on transfusion rates or any perioperative complication (P > .715). There were also no significant differences in hemoglobin or hematocrit levels immediately after surgery or on postoperative day 1. On average, patients were discharged from the hospital 1.6 days and 2.1 days postoperatively in the control and drain groups, respectively (P = .124). The average cost associated for the control cohort's hospital stay was $35,796 ± $13,078 compared with $43,219 ± $24,679 for the drain cohort (P = .063). Discussion: Drain use after shoulder arthroplasty had no appreciable difference on short-term perioperative outcomes, postoperative anemia, length of hospital stay, or cost. It is possible that the potential negative effects of postoperative drainage are blunted by the routine use of tranexamic acid.

  31. Erickson B, Campbell K, Jain A, Cvetanovich G, Higgins J, Frank R, et al. Are post-operative drains beneficial in total and reverse total shoulder arthroplasty? Openventio: Orthopedics Research and Traumatology; 2016.

    Book  Google Scholar 

  32. Codding JL, Getz CL. Pain management strategies in shoulder arthroplasty. Orthop Clin North Am. 2018;49(1):81–91.

    Article  Google Scholar 

  33. Sabesan VJ, Shahriar R, Petersen-Fitts GR, Whaley JD, Bou-Akl T, Sweet M, et al. A prospective randomized controlled trial to identify the optimal postoperative pain management in shoulder arthroplasty: liposomal bupivacaine versus continuous interscalene catheter. J Shoulder Elb Surg. 2017;26(10):1810–7 Background: Shoulder arthroplasty is the fastest growing joint replacement surgery in the United States, and optimal postoperative pain management is critical to optimize outcomes for these surgeries. Liposomal bupivacaine (LB) has gained popularity for its potential to provide extended postoperative pain relief with possibly fewer side effects. The goal of this study was to assess the impact of LB compared with continuous interscalene nerve block (CISB) in terms of postoperative pain control, outpatient pain scores, and patient-reported and functional outcomes after shoulder arthroplasty surgery. Methods: A prospective randomized controlled clinical trial compared consecutive patients undergoing shoulder arthroplasty treated with CISB vs. LB with a single bolus interscalene block. The primary outcome measures included pain assessment up to 24 hours after surgery; in addition, all doses and times of narcotics administered during the inpatient stay were recorded. Patient-reported outcome measures for pain, satisfaction, and functional outcomes were recorded postoperatively. Results: A total of 70 of 74 consecutive patients who underwent shoulder arthroplasty were included in the study. The LB group had equivalent narcotic use, pain scores, and time to first narcotic rescue compared with the CISB group within the first 24 hours (P > .05). The LB group had higher American Shoulder and Elbow Surgeons score and Penn Shoulder Score at final follow-up. There was an increased number of complications and cost for the CISB group. Conclusion: This prospective randomized controlled trial demonstrated that LB provides excellent postoperative pain relief for shoulder arthroplasty patients. In addition, LB had fewer complications and lower cost, making it a promising addition to a multimodal pain regimen for shoulder arthroplasty.

    Article  Google Scholar 

  34. DC ML, Cheah JW, Aleshi P, Zhang AL, Ma CB, Feeley BT. Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study. J Shoulder Elb Surg. 2018;27(4):686–91 Background: Studies on perioperative pain control in shoulder arthroplasty focus on regional anesthesia, with little research on other approaches. Perioperative multimodal analgesia regimens decrease opioid intake and opioid-related side effects in lower-extremity arthroplasty. In this study we compare pain scores, opioid consumption, length of stay, and readmission rates in postoperative shoulder arthroplasty patients treated with a standard or multimodal analgesia regimen. Methods: A prospective cohort analysis was performed at a single institution. Patients undergoing elective shoulder arthroplasty were treated with either a standard opioid-based regimen or a multimodal analgesia regimen perioperatively. Outcome measures included inpatient pain scores, opioid use, length of stay, and 30- and 90-day emergency department visits and readmission rates. Results: Seventy-five patients were included in each cohort. Patients treated with the multimodal analgesia regimen had lower postoperative day 0 pain scores (mean, 1.5 vs 2.2; P = .027). Opioid use in the multimodal cohort was lower on all days: 47% lower on postoperative day 0, 37% on day 1, and 44% on day 2 (all P < .01). The length of inpatient stay was significantly shorter for multimodal patients than for patients treated with the standard regimen (1.44 days vs 1.91 days, P < .01). There was no difference in the rate of 30- or 90-day emergency department visits or readmission. Conclusion: Patients undergoing shoulder arthroplasty have decreased postoperative pain and opioid consumption and shorter hospital stays when given a multimodal analgesia regimen. There is no increase in short-term complications or unplanned readmissions, indicating that this is a safe and effective means to control postoperative pain.

    Article  Google Scholar 

  35. Trasolini NA, McKnight BM, Dorr LD. The opioid crisis and the orthopedic surgeon. J Arthroplast. 2018;33(11):3379–82.e1.

    Article  Google Scholar 

  36. Hussain N, Costache I, Kumar N, Essandoh M, Weaver T, Wong P, et al. Is supraclavicular block as good as interscalene block for acute pain control following shoulder surgery? A systematic review and meta-analysis. Anesth Analg. 2020;130(5):1304–19.

    Article  CAS  Google Scholar 

  37. Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplast. 2018;33(1):90–6.

    Article  Google Scholar 

  38. Ma TT, Wang YH, Jiang YF, Peng CB, Yan C, Liu ZG, et al. Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty: a meta-analysis. Medicine (Baltimore). 2017;96(25):e7190.

    Article  CAS  Google Scholar 

  39. Okoroha KR, Lynch JR, Keller RA, Korona J, Amato C, Rill B, et al. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: a prospective randomized trial. J Shoulder Elb Surg. 2016;25(11):1742–8.

    Article  Google Scholar 

  40. Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G. Randomized controlled trial of interscalene block compared with injectable liposomal bupivacaine in shoulder arthroplasty. J Bone Joint Surg Am. 2017;99(7):550–6.

    Article  Google Scholar 

  41. Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G. Interscalene block with and without intraoperative local infiltration with liposomal bupivacaine in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2018;100(16):1373–8.

    Article  Google Scholar 

  42. Abildgaard JT, Lonergan KT, Tolan SJ, Kissenberth MJ, Hawkins RJ, Washburn R, et al. Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial. J Shoulder Elb Surg. 2017;26(7):1175–81.

    Article  Google Scholar 

  43. Bullock GS, Garrigues GE, Ledbetter L, Kennedy J. A systematic review of proposed rehabilitation guidelines following anatomic and reverse shoulder arthroplasty. J Orthop Sports Phys Ther. 2019;49(5):337–46. https://doi.org/10.2519/jospt.2019.8616.

    Article  PubMed  Google Scholar 

  44. Edwards PK, Ebert JR, Littlewood C, Ackland T, Wang A. Effectiveness of formal physical therapy following total shoulder arthroplasty: a systematic review. Should Elb. 2020 Apr;12(2):136–43. https://doi.org/10.1177/1758573218812038.

    Article  Google Scholar 

  45. Garcia GH, et al. Patient activity levels after reverse total shoulder arthroplasty: what are patients doing? Am J Sports Med. 2015. Background: The indications for reverse total shoulder arthroplasty (RTSA) continue to expand, which has resulted in younger patients who want to remain active after RTSA. Little information is available to manage expectations of both physicians and patients for return to sporting activities. Purpose: To determine the rate of return to sporting activities and assess average time to return to sports after RTSA. Methods: This was a retrospective review of consecutive RTSA patients collected from our institution’s shoulder arthroplasty registry. All patients who played sports preoperatively and had a minimum of 1-year follow-up were included. Final follow-up consisted of an additional patient-reported questionnaire with questions regarding physical fitness and sporting activities. Each patient also completed an assessment with the American Shoulder and Elbow Society (ASES) Shoulder Score and a visual analog scale (VAS) for pain. Results: Seventy-six patients played a sport preoperatively and met inclusion and exclusion criteria. The average follow-up was 31.6 months (range, 12-65 months), and average age was 74.8 years (range, 49.9-92.6 years). Average VAS pain scores improved from 6.57 to 0.63 (P < .001). Average ASES scores improved from 34.30 to 81.45 (P < .001). Subjectively, 11.8% of patients complained of stiffness and 10.5% complained of chronic pain. After RTSA, 85.5% of patients returned to at least 1 sport. Average time to return to full sports was 5.3 months. Fitness sports had the highest direct rate of return (81.5%), followed by swimming (66.7%), running (57.1%), cycling (50.0%), and golf (50%). Postoperatively, 41.1% of patients reported improved physical fitness; 88.2% felt that their sports outcome was good to excellent, and 93.4% felt that their surgical outcome was good to excellent. Conclusion: Patients undergoing RTSA had an 85% rate of return to 1 or more sporting activities at an average of 5.3 months after surgery. Age greater than 70 years was a significant predictor of decreased return to activities. The present study offers valuable information to help manage patient and surgeon expectations.

  46. SJ MI, Mackie KE, Titchener A, Gibbons R, Wang AW. Activity following reverse total shoulder arthroplasty: what should surgeons be advising? Should Elb. 2019;11(2 Suppl):4–15. https://doi.org/10.1177/1758573218793648Background: Reverse total shoulder arthroplasty (RTSA) is now the most frequently performed form of shoulder arthroplasty. There is currently no consensus on recommended levels of activity and sport following RTSA. The aim of this review is to outline the current evidence and provide a guide for surgeons on what to advise their patients regarding activity level following RTSA. Methods: A systematic review of the literature was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed using the electronic databases PubMed and Medline. Included studies were of level 1 to 4 evidence in the English language evaluating complications and return to sport after RTSA. Results: Eleven studies were selected and included a total of 621 patients (67% female) with a mean age of 73 years (range 22-92). All of the included patients participated in sports prior to RTSA. The rate of return to sport ranged from 60 to 86% and varied with the level of sport activity. Mean time to return to sport after surgery varied greatly between studies. Conclusions: Return to sport is tolerated following RTSA; however, studies are short to medium term only and although the reported complication rate is low, the studies did not include radiographic evaluation. Longer term studies with subgroup analysis evaluating common recreational activities after RTSA are required, particularly in the younger population, in order to establish clear post-operative guidelines.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MIN, USA

    Matthew Godlewski MD, Michael L Knudsen MD, Jonathan P Braman MD & Alicia K Harrison MD

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Correspondence to Alicia K Harrison MD.

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Matthew Godlewski declares that he has no conflict of interest.

Michael Knudsen declares that he has no conflict of interest.

Jonathan Braman is a consultant for Zimmer Biomet.

Alicia Harrison has received a grant from Zimmer Biomet and has received speaker honorarium from Arthrex, Inc.

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Godlewski, M., Knudsen, M.L., Braman, J.P. et al. Perioperative Management in Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 14, 282–290 (2021). https://doi.org/10.1007/s12178-021-09709-4

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