The Effect of an Early Mobilization Rehabilitation Protocol on Outcomes After Reverse Shoulder Arthroplasty

Abstract Background Given the continued growth of Reverse Shoulder Arthroplasty (RSA), it is important to optimize factors that contribute to successful outcomes. Rehabilitation after RSA is critical to achieve successful outcomes including patient function and satisfaction however, the ideal rehabilitation program has not been established. The purpose of this study was to evaluate the effect of early mobilization (EM) compared to delayed mobilization (DM) on outcomes and function following RSA. Methods A retrospective study of prospectively collected data was performed comparing 67 RSA patients in two groups: the EM group began a rehabilitation program immediately after surgery and DM group began after 4-6 weeks postoperative. Preoperative and postoperative Constant Shoulder Score (CSS), American Shoulder and Elbow Surgeons score (ASES), Penn Shoulder Score (PSS), Shoulder Satisfaction Value (SSV) as well as demographics, opioid usage, range of motion, 90-day complications, reoperation, and readmission rates were collected. Statistical analysis was performed between each group’s outcomes and for the change (delta) of outcomes from baseline to each postoperative time point. Results At 6 weeks postoperatively, EM group showed significantly higher scores in ASES function, PSS, active forward elevation, passive forward elevation, active external rotation, and passive external rotation. There was significantly lower narcotic usage in the EM group at 6 weeks. At 3 months postoperatively, the EM group showed lower numerical rating score (NRS) for pain and higher active forward elevation. At last follow-up, there was a lower NRS and greater degree for all ranges of motion for the EM group compared to the DM group. A greater change from baseline to 6 weeks postoperative was seen for EM group in SSV, ASES function, PSS, active forward elevation, passive forward elevation, and internal rotation. From baseline to 3 months postoperative, ASES pain, PSS, active forward elevation, and passive forward elevation improved significantly in the EM group. At final follow-up, active forward elevation increased greater for EM group. There were 3 complications (2 hematomas, 1 infection) in the DM group and none in the EM group. Conclusion The early mobilization rehabilitation protocol following RSA achieved lower opioid usage at 6 weeks, lower pain scores at each time point and better ROM during final follow-up compared with delayed mobilization protocol. There were no complications reported with the EM protocol, suggesting it is a safe alternative for postoperative recovery. Orthopedic surgeons should consider the early mobilization rehabilitation protocol after RSA.