New accelerated rehabilitation protocol for reverse shoulder arthroplasty – local centre experience in 2 years

Objective This study aims to evaluate the efficacy and safety of an accelerated rehabilitation protocol for reverse shoulder arthroplasty (RSA). Method A retrospective analysis was conducted on 12 patients who underwent RSA between 2021 and 2022 at the Department of Orthopaedics and Traumatology, North District Hospital. All patients received rehabilitation under a newly developed accelerated rehabilitation protocol. The protocol was divided into three phases: immediate active mobilization (weeks 1 to 6), passive mobilization and early strengthening (weeks 7 to 12), and strengthening (week 13 onwards to 26 weeks and beyond). Motions such as combined axial loading, adduction, external rotation, and extension were avoided in all phases to avoid causing anterior dislocation. Primary outcomes included the range of motion (ROM) at 1, 6, and 12 months post-operatively, and the functional and pain scores at 12 months. Secondary outcomes included complications such as fracture, dislocation, and infection. Data were collected from clinical notes, allied health documentation, and telephone interviews with patients. Results At 1 month post-operatively, the average ROM was 80° in forward flexion and 73° in abduction. At 6 months, the average ROM increased to 126° and 119°, respectively. At 12 months, the average ROM was 134° for forward flexion and 126° for abduction. The average pain score by numeric rating scale was 1.9 at 12 months. The mean Oxford shoulder score was 42.4 out of 48. No cases of dislocation, fracture, wound complication, or infection were observed. Conclusion This case series demonstrates that the accelerated rehabilitation protocol for RSA is safe and effective, with no observed complications. Future studies may focus on identifying poor prognostic factors that would predict an inferior outcome. Studies with larger sample sizes and comparative designs are needed to confirm these findings and optimize rehabilitation strategies.