Background: As shoulder arthroplasty (SA) volume rises globally, evidence on optimal perioperative rehabilitation and analgesia is limited.This systematic review evaluated ERAS postoperative strategies on patient-reported outcomes and satisfaction.Methods: PubMed, Embase, MEDLINE, Global Health, and Cochrane Library were searched per PRISMA 2020.Studies undergoing total (TSA) or reverse total shoulder arthroplasty (RTSA) were included.Interventions: rehabilitation timing and analgesic protocols.Outcomes: American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), range of motion (ROM), Quality of Recovery-15 (QoR-15), and satisfaction.Results: Eighteen studies including 1,722 patients (TSA: n = 7; RTSA: n = 2; mixed: n = 9) were analysed.Delayed rehabilitation after RTSA improved early pain scores (ASES pain 26.3 16.3 vs 16.7 11.6 at 6 months; P = 0.01) and overall function (ASES total 40.2 20.1 vs 30.0 18.8; P = 0.04), without affecting long-term outcomes (ASES 88-90, SST 9.8-9.9,SANE 85-88 at 12 months).Opioid-sparing and opioid-free protocols achieved equivalent functional recovery (ASES 74-89, SST 6-9, SANE 24-28 change-from-baseline) and consistently higher patient satisfaction (86-97%) at 2-6 weeks.Continuous interscalene blocks and liposomal bupivacaine provided effective analgesia (QoR-15 POD 3: 124.5-132.0),with trends toward improved early recovery.Across studies, ROM outcomes (forward flexion 126-146 and external rotation 57-62) were comparable, indicating multiple ERAS strategies can deliver similar functional and patient-reported outcomes while enhancing early recovery and satisfaction. Conclusion:Functional recovery following SA appeared robust across diverse rehabilitation and analgesic strategies.Delayed rehabilitation offered early pain advantages, and opioidsparing approaches enhanced patient satisfaction without compromising outcomes.These findings supported a personalised, patient-centred approach to postoperative care and J o u r n a l P r e -p r o o f highlight the need for further high-quality comparative trials.Level of evidence: Narrative Review
Shinwari et al. (Sun,) studied this question.