Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

• Published in: European Journal of Orthopaedic Surgery & Traumatology Vol. 33; no. 7; pp. 2951 - 2957
• Main Authors: Tuphe, P., Caubriere, M., Hubert, L., Lancigu, R., Sakek, F., Loisel, F., Obert, L., Rony, L.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.10.2023; Springer Nature B.V; Springer-Verlag
• Subjects: Aged; Arthroplasty, Replacement, Shoulder; Human health and pathology; Humans; Humerus; Life Sciences; Medicine; Medicine & Public Health; Original; Original Article; Range of Motion, Articular; Rehabilitation; Retrospective Studies; Shoulder; Shoulder Fractures; Shoulder Joint; Shoulder Prosthesis; Surgical Orthopedics; Traumatic Surgery; Treatment Outcome; Early physical therapy; Reverse total shoulder replacement; Elderly subject; Proximal humerus fracture
• ISSN: 1432-1068; 1633-8065; 0948-4817; 1432-1068
• DOI: 10.1007/s00590-023-03505-1

Purpose Reverse total shoulder arthroplasty (RSA) has revolutionized the management of proximal humerus fractures (PHF) in the elderly patients. There is few or no consensus regarding to management of postoperative rehabilitation in elderly patients. An early rehabilitation from D1 allowed better functional results compared to rehabilitation started to D30 independently from tuberosities consolidation. Methods 94 patients operated on for PHF were evaluated retrospectively, with a minimum radio-clinical follow-up of 2 years. Clinical evaluation included mobilities and four functional scores: ASES, quick DASH, gross constant, weighted constant. Radiological evaluation was performed on a frontal shoulder X-ray with evaluation of tuberosities’ consolidation. Results The mean follow-up was 45 ± 19 months (24–88 months). Early rehabilitation was significantly associated with a better Constant Score (71.1 ± 17.2 vs. 56.4 ± 15.8; p  < 0.001), better adjusted Constant score (92.4 ± 14.2 vs. 80.3 ± 19.5; p  < 0.001), better quick DASH (22.8 ± 19.8 vs. 36.7 ± 21.3; p  < 0.01), better ASES (78.6 ± 20.2 vs. 63 ± 22; p  < 0.001). Conclusion In traumatology, functional result of RSA seems not related in tuberosities’ union but in rehabilitation in order to limit postoperative stiffness of operated shoulder. An early rehabilitation is related with better clinical and functional results, independently of tuberosities’ union. Level of evidence 3, control-case study.